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[Late reversal reactions in leprosy]
B Flageul1, M D Vignon-Pennamen, D Wallach
1Service de Dermatologie du Pr Dubertret, Hôpital Saint-Louis, Paris, France.
Acta Leprologica
|January 1, 1990
Summary
Late reversal reactions (RR) after leprosy treatment are uncommon after monosulphonotherapy but can occur years later. Comprehensive evaluation is crucial for accurate diagnosis and management of these difficult cases.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Multidrug therapy (MDT) is standard for leprosy treatment.
- Reversal reactions (RR) can occur post-treatment, but late RR after monosulphonotherapy are rarely documented.
- Leprosy endemic areas face diagnostic and therapeutic challenges with late RR.
Observation:
- Five cases of late reversal reactions (RR) are presented.
- Four cases occurred 1.5 months to 3 years after multidrug therapy (MDT) cessation in patients with borderline tuberculoid (BT) and borderline lepromatous (BL-LLs) leprosy.
- One case of Lucio's phenomenon (LLs) experienced late RR 6 months after stopping 14 years of monosulphonotherapy.
Findings:
- Late RR can manifest significantly after both MDT and prolonged monosulphonotherapy.
- Clinical, bacteriological, and immunological assessments are vital for differentiating late RR from relapses.
- Monosulphonotherapy, even long-term, does not preclude the occurrence of late reversal reactions.
Implications:
- Highlights the need for continued vigilance and comprehensive patient evaluation post-leprosy treatment.
- Suggests that diagnostic protocols should incorporate detailed clinical and immunological assessments beyond bacteriology.
- Emphasizes that late RR are a potential complication even after historical treatment regimens like prolonged monosulphonotherapy.