Hepatic morphology in reactional states of leprosy

Liver function tests and liver biopsies were studied in 23 leprosy patients in reaction and 10 without reaction. The liver biopsies in leprosy patients with reaction showed exudative lesions, epithelioid and tuberculoid granulomas, and foam-cell granulomas. Portal vasculitis was encountered in a few cases. Neutrophilic infiltration into the foam-cell granulomas was seen in a few cases of lepromatous (LL) leprosy with reaction. In six cases of borderline (BL, BB and BT) leprosy with reaction, a spectrum of lesions bearing footprints of exudative lesions were seen evolving into epithelioid-cell granulomas. Foam-cell granulomas and tuberculoid and epithelioid granulomas along with exudative lesions were encountered in two cases on individual biopsy strips. An altered albumin-to-globulin ratio was the chief functional derangement observed in these cases. The spectrum of changes observed in borderline leprosy with reaction could be discrete steps in the evolution of upgrading reaction.