Diagnosis of Erythema Nodosum Leprosum (Type 2 Reaction) by Cytology

Abstract

Objective: It was the aim of this study to evaluate the possible role of cytology in erythema nodosum leprosum (ENL) and its use for early treatment of the disease. Study Design: We present a prospective study conducted with 15 clinically diagnosed ENL cases. Among them, 13 cases had previously been diagnosed with lepromatous leprosy (LL) and 2 patients were new LL cases with signs and symptoms of ENL lesions. Haematoxylin and eosin stain with modified Ziehl-Neelsen stain was performed on fine needle aspiration material. One case was sent for biopsy. Results: Complete cytological diagnosis of ENL was done in all 15 cases. Histopathological study revealed classical ENL lesions which also showed ENL features in cytodiagnosis. Conclusion: In the past, the accurate mode of diagnosis of ENL lesions was histopathology. However, clinicians have to wait a long time for the report and generally they start treatment only on the basis of clinical signs and symptoms. Cytodiagnosis of ENL lesions is an early, effective method for accurate diagnosis and helps to initiate treatment for these painful lesions.

Expression of CD64 on Circulating Neutrophils Favoring Systemic Inflammatory Status in Erythema Nodosum Leprosum

“…ENL affects the skin and other organs and frequently presents systemic symptoms of the acute infections syndrome with high leukocytosis levels and intense malaise clinically similar to sepsis [8,9]. For several years, it was assumed that the main mechanism involved in ENL was the deposition of the immune complex, as evidenced by granular deposits of immunoglobulin and complement in perivascular [10] and extravascular sites, detection of immune complexes in vessel walls, and injured endothelial cells [11].…”

Cytological diagnosis of erythema nodosum leprosum in clinically unsuspected cases: A report of two cases

“…Young patients, patients with high bacillary index, and those with skin infiltration are more prone for development of ENL reactions. [ 9 ]…”

“…[ 4 ] Our paper highlights the role of FNAC in diagnosing two clinically unsuspected cases of ENL, while most authors have described cytological findings of ENL in clinically suspected cases of reactionary leprosy. [ 4 6 8 9 ] Because ENL can involve unusual sites and can occasionally be the presenting feature of the disease, this possibility should be excluded in smears showing suppurative inflammation with macrophages and granuloma formation.…”