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Necrotic erythema nodosum leprosum.

Vandana Mehta Rai¹, C Balachandran

¹Department of Skin and STD, Kasturba Medical College, Manipal, Karnataka. vandanamht@yahoo.com

Dermatology Online Journal

|April 28, 2006

Summary

Lepromatous leprosy can manifest with severe skin complications, including painful bullous lesions and ulcers. Histopathology confirmed erythema nodosum leprosum as the cause of these severe skin manifestations.

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Area of Science:

Dermatology
Infectious Diseases
Pathology

Background:

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, can present with diverse clinical manifestations.
Lepromatous leprosy is the most severe form, often associated with significant dermatological complications.
Erythema nodosum leprosum (ENL) is a common inflammatory complication of lepromatous leprosy.

Observation:

A 32-year-old fisherman with lepromatous leprosy developed acute symptoms including fever, arthralgia, and extensive bullous lesions.
The bullae ruptured, forming numerous well-defined ulcers with necrotic bases, some resembling eschars.
Immunofluorescence studies excluded autoimmune bullous dermatoses.

Findings:

Histopathological examination of a skin lesion revealed characteristic features of erythema nodosum leprosum.
The clinical presentation and histopathological findings strongly indicated ENL as the underlying cause of the bullous and ulcerative lesions.

Implications:

This case highlights the severe and potentially debilitating dermatological manifestations of lepromatous leprosy, specifically ENL.
Accurate diagnosis through histopathology is crucial for managing ENL and preventing further complications.
Effective management of ENL is essential for improving patient quality of life in leprosy.

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