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Leprosy type 1 reaction as the first manifestation of borderline lepromatous leprosy in a young native German
Author(s) -
BIEDERMANN T.,
DEGITZ K.,
SCHIRREN C.G.,
BURGDORF W.,
PLEWIG G.,
BIEBER T.
Publication year - 1997
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.1997.20032093.x
Subject(s) - leprosy , mycobacterium leprae , medicine , lepromatous leprosy , tuberculoid leprosy , neuritis , skin biopsy , rifampicin , dermatology , serology , biopsy , pathology , nerve biopsy , tuberculosis , immunology , peripheral neuropathy , surgery , antibody , diabetes mellitus , endocrinology
Summary While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. Leprosy rarely presents with a reaction. We describe a German patient who presented in this unusual way in order to demonstrate the various tools used to confirm the diagnosis. A young German woman suddenly developed progressive functional loss of the left hand and within a few weeks an increasing number of erythematous macules and nodules appeared. Histological examination of a skin biopsy revealed tuberculoid granulomas, some located around small nerves: acid‐fast bacilli were detected microscopically and DNA from Mycobacterium leprae was identified by polymerase chain reaction in the biopsy and a nasal swab: serological tests were positive. The disease was classified as borderline lepromatous leprosy. The acute neuritis followed by skin lesions represented a leprosy type 1 reaction in which the immune system reacts to bacilli previously unrecognized in nerve tissue, both in nerve and skin.