Histopathological study of ocular erythema nodosum leprosum and post-therapeutic scleral perforation: A case report

Abstract

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, clinically present either as tuberculoid, borderline or lepromatous type. Erythema nodosum leprosum (ENL) is an acute humoral response in the chronic course of lepromatous leprosy. Although very severe ENL reactions are known in systemic leprosy, such severity is rare in ocular tissues. A leprosy uveitis patient suffered from a severe form of post- therapeutic ENL reaction which resulted in perforation of the globe at the site of preexisting subconjunctival leproma. Painful blind eye was enucleated. Histopathological study revealed infiltration of numerous polymorphs and macrophages packed with acid-fast bacilli in the conjunctiva, cornea, ciliary body, ora serrata and sclera. A profuse influx of neutrophils on a background of macrophages packed with M. leprae confirmed the ocular ENL reaction. This case is reported to alert the ophthalmologists to a rare ocular complication of ENL.

Ocular erythema nodosum leprosum: An immunohistochemical study

“…On histopathology, massive collections of macrophages containing large numbers of acid-fast lepra bacilli were seen in the hypopyon. [ 3 ]…”

“…ENL is an acute inflammatory response in LL. [ 1 2 3 4 5 6 7 ] ENL reaction is characterized by an influx of neutrophils at the site of leprosy lesions. The histologic changes of ocular tissue observed in this study were similar to those observed in the skin lesions of ENL.…”

Leprosy Uveitis in the Developing World

“…7 They may coalesce and become pedunculated; on occasion, these lesions may break off the iris and drop into the anterior chamber. 31 Although reported, hypopyon is very rare in leprosy. MB patients with high bacterial index constitute a risk for developing uveal involvement throughout the course of the disease and even after completing MDT.…”