Erythema nodosum leprosum: Report of two cases

Abstract

Erythema nodosum leprosum (ENL) or type 2 lepra reaction is an inflammatory reaction, which may occur in the course of hanseniasis, may compel the patient to seek medical attention and may result in nerve function impairment and subsequent disability. Thus, recognition and timely management of these patients is critical in order to avoid permanent disability. Fine-needle aspiration cytology is simple and effective tool that aids in the correct diagnosis and management of ENL. Herein, we present two cases of ENL, one with typical and another with atypical presentation.

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

“…Our cytological findings are similar to those in the studies of Malik et al [3], Aggarwal et al [10] and Nigam et al [14], with a large number of neutrophils, foamy macrophages, acid-fast bacilli positivity with fragmented bacilli and an inability to demonstrate the vasculitis features. Histopathological findings showed neutrophilic infiltration into lepromatous granuloma, fragmented lepra bacilli and vasculitis that correlated with the findings of Aggarwal et al [10] and Siddaraju et al [11].…”

“…Histopathological findings showed neutrophilic infiltration into lepromatous granuloma, fragmented lepra bacilli and vasculitis that correlated with the findings of Aggarwal et al [10] and Siddaraju et al [11]. …”

“…Later, studies have attempted, with fair success, to diagnose and categorize leprosy according to the Ridley-Jopling classification based on cytological findings of cytopuncture, slit skin smears and fine needle aspiration technique; however, studies on cytological diagnosis of ENL lesions are few in number [10,11]. It is documented that ENL lesions are most frequently associated with LL cases [12,13].…”

“…We have modified the histological [10,11] criteria for cytology diagnosis. The presence of abundant neutrophils in an admixture of macrophages and fragmented lepra bacilli (BI 1+ to 5+ and low morphological index) are criteria for classifying these cases as type 2 reaction.…”