Case Report: Erythema nodosum leprosum before receiving treatment and improvement with leprosy treatment

سال انتشار: 1396
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 439

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شناسه ملی سند علمی:

ACPLMED19_067

تاریخ نمایه سازی: 20 آبان 1397

چکیده مقاله:

Introduction: Leprosy is an old, chronic, granulomatous, infectious disease and has two major reactions state. Type one (reversal reaction) and type two or erythema nodosum leprosum (vasculitis) (ENL). Case Presentation: A 53- year- old man presented with symmetric erythematous papulonodular lesions all over the body Since 1 year ago. One month ago he suffered erythematous and ulcerative lesions on bilateral legs. He received topical treatment such as corticosteroid during this year, but he had no clinical mprovement. An examination of lower extremities demonstrated bilateral painful palpable purpuric and erythematous plaques with punched-out ulcers, pitting edema.With suspicion of lepromatous leprosy, we prepared smear from one nodule on the trunk. Many acid fast bacilli were seen on ziehl neelsen staning .Two punch biopsy were done from purpuric lesions of the leg and trunk nodules. Pathology confirmed our diagnosis and biopsy of leg lesion which was compatible with erythema nodosum leprosum. Therefore multi drug treatment (Dapson, Rifampin and Clofazemine) started for him and significant improvement of all skin and mucosal lesions, even ENL was seen after 8 weeks follow up. No additional therapy for ENL such as Thalidomide or Corticosteroid was needed. Conclusion: ENL is presented with multiple painful nodules and erythematous infiltrated or ulcerated patches which seen suddenly on extremities. Treatment of these reactions is very important because they are the major cause of nerve function impairment which leads disability caused by leprosy, so misdiagnosed or untreated conditions have significant morbidity and mortality.

نویسندگان

Reza Robati

Skin Research Center, Shahid Beheshti University of Medical Sciences Shohada-e-Tajrish Hospital,Tehran, Iran

Nasim Niknezhad

Skin Research Center, Shahid Beheshti University of Medical Sciences Shohada-e-Tajrish Hospital,Tehran, Iran

Zeinab Bizaval

Skin Research Center, Shahid Beheshti University of Medical Sciences Shohada-e-Tajrish Hospital,Tehran, Iran

Farahnaz Bidari Zerehposh

Department of Pathology, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran