Abstract
Erythema nodosum leprosum (ENL) is an acute immune complex-mediated condition of the dermis, subcutaneous tissue, and other tissues seen in patients with multibacillary (MB) leprosy, causing severe impairment to patients’ quality of life. To date, there is no standard diagnostic criteria for ENL. We aimed to study the diagnostic value and accuracy of Neutrophil-to-Lymphocyte ratio (NLR), Lymphocyte-to-Monocyte ratio (LMR), and Platelet-to-Lymphocyte ratio (PLR) in diagnosing ENL. This is an analytic retrospective study with a cross-sectional design that describes the distribution and clinical characteristics of all newly diagnosed MB patients of Dr. Soetomo General Hospital Surabaya in the years 2018–2020. NLR, LMR, and PLR were calculated for all patients, and a receiver operating characteristic curve (ROC) was generated to identify the cut-off points. Among a total of 182 patients with MB leprosy, 22 cases (12.09%) were reported with ENL. WBC, neutrophils, monocytes, and thrombocytes showed a positive correlation with the incidence of ENL, but not lymphocytes. The NLR cut-off point for the diagnosis of ENL was 4.99 (sensitivity 86.4%, specificity 82.5%, accuracy 82.97), while that of PLR was 237.46 (sensitivity 63.6%, specificity 73.1%, accuracy 71.98%). LMR had poor sensitivity and specificity levels of 50% and 28.7%, with cut-off point of 2.28 and accuracy of 31.32%. These results suggest that NLR and PLR could be potential biomarkers for the diagnosis of ENL.
Highlights
Leprosy is one of 20 neglected tropical diseases caused by Mycobacterium leprae, with more than 200,000 new cases reported every year from more than 120 countries [1,2]
This study describes the distribution and clinical characteristics of Erythema nodosum leprosum (ENL), showing a relatively low incidence corresponding to 12.09% of all new MB patients
A previous study by Fransisca C., et al [13] in the same hospital in 2015–2017 reported a higher ENL incidence of 33% in all MB cases. This difference may be related to the fact that in this study, we eliminated a group of patients, who could have been suffering from ENL but did not perform the necessary laboratory analysis to complete the study
Summary
Leprosy is one of 20 neglected tropical diseases caused by Mycobacterium leprae, with more than 200,000 new cases reported every year from more than 120 countries [1,2]. Erythema nodosum leprosum (ENL) is an acute inflammatory complication of leprosy that exclusively occurs in MB leprosy [5,6]. It presents as a sudden onset of generalized painful erythematous nodules with or without symptoms of systemic inflammation that may occur before, during, or after multi-drug therapy (MDT) [6–8]. Naafs et al for leprosy diagnosis are considered sufficient in daily clinical practice, histopathological findings such as findings such as increased vascularity with dilated capillaries in the dermis with neutrophil infiltration may aid in disease confirmation [9]. The diagnosis of ENL often relies on the medical expertise of doctors and their ability to recognize the disease’s clinical manifestations [10]. The increase of acute-phase proteins, such as C-reactive protein, gamma globulin, α1-antitrypsin, and α1-acid glycoprotein, may help the diagnosis, related tests are often expensive and not available [10]
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