Immune reconstitution inflammatory syndrome unmasking erythema nodosum leprosum: A rare case report

Arakkal, Geeta Kiran; Damarla, Sudha Vani; Chanda, Geetha Madhuri

doi:10.4103/0019-5154.147883

Cited by 6 publications

(2 citation statements)

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“…31 Classical features of vasculitis and thrombus formation have been demonstrated. 43 It is not surprising that an infection with TW causes a similar response pattern in the skin as in leprosy. For instance, neutrophils in vessel walls were only detected in 12% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Vascular changes in ENL have been described as common. [41][42][43] In all 3 cases, ART led to ENL as a sign of reactional lepromatous leprosy because of a change in the immunological state (rapid restoration of T-cell number, as an example). 32,33 A recent study of Adhe et al 34 found a neutrophilic panniculitis in 66% patients with leprosy type 2 reactions (ENL), but all the diagnostic features of vasculitis could not be detected in most of the biopsies.…”

Section: Discussionmentioning

confidence: 99%

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Erythema Nodosum Leprosum–Like Lesions Are a Histopathologic Pattern in Whipple's Disease and a Sign of the Immune Reconstitution Inflammatory Syndrome: A Case Series and Review of the Literature

Liersch¹,

Carlotti

Theunis

et al. 2017

The American Journal of Dermatopathology

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Inflammatory and subcutaneous nodules can arise in treated and untreated cases of Whipple disease (WD). The inflammatory immune reconstitution syndrome describes paradoxical clinical inflammatory worsening of a preexisting condition because of a return of immune function. Clinicopathologic examination of 4 patients with WD who presented with erythema nodosum leprosum (ENL)-like lesions and the findings of a systematic review of this phenomenon revealed that ENL-like lesions occurred in predominantly middle-aged male patients who suffered from WD, mostly on the legs. Patients showed a nonvasculitic, mostly septal panniculits with neutrophils, macrophages, and lymphocytes. Numerous bacteria-laden periodic acid-Schiff + macrophages and free bacilli were detected in the dermis, as well as subcutaneous septae and adipose lobules. These lesions occurred in both untreated and treated patients as part of inflammatory immune reconstitution syndrome. In conclusion, ENL-like lesions represent a characteristic histopathologic pattern associated with WD, which can occur in different contexts whenever there is a change in the immunological status of the patient. This change can be triggered by antimicrobial treatment, immunomodulatory and immunosuppressant therapy, or occur spontaneously, rarely.

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Section: Discussionmentioning

confidence: 99%