Multibacillary leprosy patients with high and persistent serum antibodies to leprosy IDRI diagnostic-1/LID-1: higher susceptibility to develop type 2 reactions

Leprosy inflammatory episodes [type 1 (T1R) and type 2 (T2R) reactions] represent the major cause of irreversible nerve damage. Leprosy serology is known to be influenced by the patient’s bacterial index (BI) with higher positivity in multibacillary patients (MB) and specific multidrug therapy (MDT) reduces antibody production. This study evaluated by ELISA antibody responses to leprosy Infectious Disease Research Institute diagnostic-1 (LID-1) fusion protein and phenolic glycolipid I (PGL-I) in 100 paired serum samples of 50 MB patients collected in the presence/absence of reactions and in nonreactional patients before/after MDT. Patients who presented T2R had a median BI of 3+, while MB patients with T1R and nonreactional patients had median BI of 2.5+ (p > 0.05). Anti-LID-1 and anti-PGL-I antibodies declined in patients diagnosed during T1R (p < 0.05). Anti-LID-1 levels waned in MB with T2R at diagnosis and nonreactional MB patients (p < 0.05). Higher anti-LID-1 levels were seen in patients with T2R at diagnosis (vs. patients with T1R at diagnosis, p = 0.008; vs. nonreactional patients, p = 0.020) and in patients with T2R during MDT (vs. nonreactional MB, p = 0.020). In MB patients, high and persistent anti-LID-1 antibody levels might be a useful tool for clinicians to predict which patients are more susceptible to develop leprosy T2R.

An unusual presentation of leprosy at diagnosis: erythema multiforme-like type 2 reaction

Este estudo descreve um caso de Eritema Multiforme (EM) como a primeira manifestação clínica de Hanseníase (MH) em uma mulher de 35 anos. Quando atendida em um Hospital, a paciente apresentava febre, artralgia, e placas eritematosas em ambos os cotovelos e joelhos bilateralmente, algumas com bolhas e/ou necrose central. O diagnóstico foi confirmado por meio de biópsias de pele, que revelaram um padrão histopatológico compatível com EM, além da presença decélulas de Virchow e bacilos álcool-ácido resistentes (BAAR). Médicos em geral, especialmente os clínicos, devem considerar MH como diagnóstico diferencial de EM, especialmente em regiões endêmicas da doença.

This study describes a case of erythema multiforme (EM) as the first clinical manifestation of leprosy in a 35-year-old woman. She presented at the hospital with fever, arthralgia and erythematous plaques on both elbows and knees, some of them with bullous or necrotic center areas. The diagnosiswas confirmed by skin biopsy, which revealed a well-known EM pattern, and also showed the presence of Virchow cells and acid-fast bacilli. Physicians should be aware that leprosy must beconsidered in the differential diagnosis of EM, especially in endemic regions.