English

Abstract

Leprosy is an ancient disease that has survived into the modern ages despite an intense effort to eliminate it worldwide.[1] Here we report a case of recurrent, multiple ulcerative lesions with pitting edema of both lower extremities, in a 62 years old male. He was a diagnosed case of Hansen’s disease with irregular treatment since 2 years. All biochemical parameters were within normal limits. Rheumatoid factor, ANA, ELISA for HIV and VDRL were negative. Modified ZN staining (using 5% sulphuric acid) shows acid fast bacilli (grading +++), arranged in globi, 65% were fragmented & 35% were uniformly stained. Organisms isolated in bacterial culture were Proteus mirabilis & Staphylococcus aureus & Candida spp isolated in fungal culture. Patient was admitted and was started on MDT-MB along with prednisolone. KEY-WORDS: Erythema nodosum leprosum, Mycobacterium leprae, Modified ZN stain INTRODUCTION: Leprosy is an ancient infectious disease caused by Mycobacterium leprae that affects the skin and peripheral nerves. A wide clinical spectrum of disease exists, from the tuberculoid pole [associated with a vigorous Th1 response, relatively few bacilli, and limited well-defined lesions] to the lepromatous pole [associated with aggressive Th2 response, many bacilli, and diffuse symmetric lesions].[2] Though it is a chronic disease, it has tendency for debilitating acute exacerbations termed reactions; Type 1 Reaction [Reversal Reaction] and Type 2 Reaction [Erythema Nodosum Leprosum (ENL)].[1] Erythema nodosum leprosum, is an acute inflammatory reaction seen in patients with lepromatous leprosy or occasionally in borderline lepromatous leprosy.[3] Though it is usually seen during the course of treatment it may occur in previously untreated patients as well.[4] The lesions are erythematous painful tender papules and nodules. In mild reaction nodules are small in number and spontaneously resolve leaving behind hyperpigmented macules.[5] In severe reactions, nodules tend to increase in size and ulcerate. Vesiculobullous, pustular, ulcerated, and hemorrhagic and erythema multiforme-like lesions have been reported in ENL.[6] In this article, we have discussed a case which presented to us with recurrent, multiple ulcerative lesions with pitting edema of both lower extremities. The case was admitted in our hospital, Pradumna Bal Memorial Hospital, KIMS, Bhubaneswar, where he was investigated, diagnosed and started on treatment. CASE REPORT: A 62 year old male was presented with multiple painful ulcerated skin lesions over both the lower extremities and gluteal areas of 3 months duration. He had history of recurrent attacks of papulo-pustular lesions, and ulcerations since two years. The skin lesion