Erythema nodosum secondary to type 2 reaction as a manifestation of lepromatous leprosy. A case report Eritema nudoso secundario a reacción tipo 2 como manifestación de lepra lepromatosa. Un reporte de caso

Abstract

Introduction: Erythema nodosum leprosum, or type 2 leprosy reaction, is a type III humoral immunological reaction in the lepromatous and borderline categories of the disease This classically presents as painful subcutaneous nodules on the skin, and other systemic manifestations. In this case report, a typical form of this type of leprosy reaction will be shown.
Case presentation: A 28year-old male patient diagnosed and being treated for multibacillary lepromatous leprosy, was referred to the San Jose Hospital one month after onset. He presented with clinical symptoms such as fever, malaise, weight loss, and increased nodular lesions in the upper limbs, with additional finding of bi-cytopenia and severe neutropenia. He was evaluated by the Dermatology Department during his hospital stay, where he was diagnosed with erythema nodosum leprosum and began treatment for it. A further improvement was observed in the neutropenia, with an increase in leucocytosis. The presence of blasts was found in the peripheral blood smears, which led to the suspicion that the patient had a haemato-lymphoid disease. This was evaluated by the haematology department, but was ruled out. Therefore, this condition corresponded to a leukemoid reaction, probably secondary to the underlying disease. Finally, the patient progressed well and was discharged without complications.
Conclusions: Type 2 leprosy reaction is an immune reaction mediated by the immunecomplex that occurs typically as painful subcutaneous nodules on the skin, in addition to the associated constitutional symptoms and damage to other organs such as liver, kidney and bone marrow. Knowledge of leprosy reactions, and their timely diagnosis and treatment are essential in preventing morbidity and mortality in these patients.