Type I lepra reaction presenting as immune reconstitution inflammatory syndrome

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is an unusual inflammatory reaction due to infectious and non-infectious causes occurring in human Immunodeficiency virus (HIV)-infected patients. IRIS occurs after the initiation of antiretroviral therapy. There are no reports of type I lepra reaction due to IRIS in published literature from India. We report two cases of HIV-infected males who presented with borderline tuberculoid leprosy in type 1 reaction after the initiation of highly active antiretroviral treatment (HAART). Case 1 presented with multiple, tender, erythematous and hypoesthetic plaques on the trunk and extremities after 3 months of antiretroviral therapy. In case 2, type I lepra reaction was observed 2 months after the initiation of HAART.

Leprosy Reversal Reaction as Immune Reconstitution Inflammatory Syndrome in Patients with AIDS

“…In addition to the 2 cases described here, there have been 14 other reports of leprosy as a manifestation of IRIS [10][11][12][13][14][15][16][17][18]. The reports are listed in table 1.…”

“…Leprosy has been described as a manifestation of IRIS in few instances [10][11][12][13][14][15][16][17][18]. We describe 2 patients with AIDS who developed reactional borderline leprosy as a manifestation of IRIS after they started receiving antiretroviral treatment, and we review reports regarding similar patients from the literature.…”

Leprosy and Kaposi sarcoma presenting as an immune reconstitution inflammatory syndrome in a patient with AIDS

“…In contrast, in classic type-1 leprosy reactions, there is initial lysis of bacilli by multidrug therapy that then restores the immune system and this reconstituted immune response leads to a type-1 reaction. 11,16 Furthermore, all reported cases belong to the tuberculoid spectrum of leprosy, implying that there is a good immune host response. This is not true for two patients (including the current one) with borderline lepromatous multibacillary disease; these patients were probably anergic against mycobacteria and as HAART increased cellular immune response, it triggered reactional type-1 leprosy, instead of type-2 reactions.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15] Since its first report in 2003, it has become clear that the introduction of HAART changed the natural history of leprosy in HIV-infected patients. 3,15 In 19 cases (including the patient we describe) the clinical manifestations of IRIS were leprosy type-1 reactions, some unusually severe and associated with vasculitis and ulcerous progression.…”

Reversal Reaction as a Manifestation of Immune Reconstitution Inflammatory Syndrome

“…The mean time that patients developed reaction after initiation of HAART was 18.95 (4-172) weeks (median:8, Mode:8, standard deviation:31,1) (Tables 1 and 2). Twenty three (56.09%) of the cases were from Brazil (Pereira et al, 2004;Visco-Comandini et al, 2004;Trindade et al, 2005;Talhari et al, 2007;Caruso et al, 2007;Batista et al, 2008;Deps et al, 2008& Menezes et al, 2009, 13 (31.7%) from India (Narang et al, 2005;Singal et al, 2006;Kharkar et al, 2007;Kar et al, 2009&Vinay et al, 2009, 3 (7.31%) from Haiti (Couppié et al, 2004& Pavie et al, 2009), 1 (2.43%) from Uganda (Lawn et al, 2003) and 1(2.43%) from French Guiana (Couppié et al, 2004). Thirty one (75.6%) patients were man and 10 (27.3%) women.…”