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Correspondence |

Necrotic Erythema Nodosum Leprosum as the First Manifestation of Borderline Lepromatous Leprosy

Athanasia Tourlaki, MD; Angelo V. Marzano, MD; Raffaele Gianotti, MD; Paolo Fiallo, MD; Enrico Nunzi, MD; Elvio Alessi, MD
Arch Dermatol. 2008;144(6):818-820. doi:10.1001/archderm.144.6.818.
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Erythema nodosum leprosum (ENL) is an immune complex–mediated reaction that may complicate the course of multibacillary leprosy. It generally occurs during antimycobacterial treatment and presents with multiple erythematous tender nodules, which add to preexisting leprosy lesions.1

Meyerson  MS Erythema nodosum leprosum. Int J Dermatol 1996;35 (6) 389- 392
PubMed Link to Article[[XSLOpenURL/10.1111/ijd.1996.35.issue-6]]
Rea  THLevan  NE Erythema nodosum leprosum in a general hospital. Arch Dermatol 1975;111 (12) 1575- 1580
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.1975.01630240031005]]
Wong  WS Leprosy presenting as nodular vasculitis. Br J Rheumatol 1987;26 (5) 398
PubMed Link to Article[[XSLOpenURL/10.1093/rheumatology/26.5.398]]
Ramesh  VSaxena  UMukherjee  AMisra  RS Multiple ulcers in an elderly man: necrotizing erythema nodosum leprosum (ENL) (necrotizing ENL). Arch Dermatol 1992;128 (12) 1643- 1646
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.1992.04530010081013]]
Verma  KKPandhi  RK Necrotic erythema nodosum leprosum: a presenting manifestation of lepromatous leprosy. Int J Lepr Other Mycobact Dis 1993;61 (2) 293- 294
PubMed
Nishioka  SAGoulart  IMBurgarelli  MKFerreira  MSNunes-Araújo  FR Necrotizing erythema nodosum leprosum triggered by cotrimoxazole? Int J Lepr Other Mycobact Dis 1994;62 (2) 296- 297
PubMed
Anshu [sic]Gangane  NVagha  SSamal  N Cytodiagnosis of erythema nodosum leprosum: a case report. Acta Cytol 2002;46 (2) 386- 387
PubMed Link to Article[[XSLOpenURL/10.1159/000326738]]
Pandhi  DMehta  SAgrawal  SSingal  A Erythema nodosum leprosum necroticans in a child: an unusual manifestation. Int J Lepr Other Mycobact Dis 2005;73 (2) 122- 126
PubMed
Chauhan  SD'Cruz  SMohan  HSingh  RRam  JSachdev  A Type II lepra reaction: an unusual presentation. Dermatol Online J 2006;12 (1) 18
PubMed
Andreoli  ABrett  SJDraper  PPayne  SNRook  GA Changes in circulating antibody levels to the major phenolic glycolipid during erythema nodosum leprosum in leprosy patients. Int J Lepr Other Mycobact Dis 1985;53 (2) 211- 217
PubMed
Symmers  WS Sudden appearance of a lepromatous eruption during prolonged administration of stilbestrol: a case of unsuspected leprosy. Int J Lepr 1951;19 (1) 37- 43
PubMed
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Figure 1.

Necrotic erythema nodosum leprosum. A, Erythematous nodules on the dorsal surface of the hand; B, targetoid skin lesions with red borders and central vesicobullae together with atrophic scars over the lower extremity; and C, ulcerative lesions covered by necrotic eschars and surrounded by an erythematous-violaceous flare.

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Figure 2.

Borderline lepromatous leprosy. A, Lamination of the perineurium with an “onionskin” appearance (hematoxylin-eosin, original magnification ×200); inset, Fite-Faraco stain shows numerous acid-fast bacilli in a skin biopsy specimen (original magnification ×400). B, Granuloma containing numerous neutrophils and foamy macrophages consistent with erythema nodosum leprosum (hematoxylin-eosin, original magnification ×400).

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