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Ocular erythema nodosum leprosum: An immunohistochemical study
S R Rathinam1, Jignesh G Parikh2, Narsing A Rao3
1Uveitis Service, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India.
Indian Journal of Ophthalmology
|August 23, 2020
Summary
Ocular leprosy can manifest as episcleritis, scleritis, and uveitis. Severe Erythema Nodosum Leprosum (ENL) can cause globe perforation, as shown by immunohistochemical analysis of inflammatory cells in ocular tissues.
Area of Science:
- Ophthalmology
- Immunology
- Dermatology
Background:
- Ocular leprosy commonly presents with episcleritis, scleritis, and anterior uveitis.
- Erythema Nodosum Leprosum (ENL) is a severe systemic immune reaction complicating leprosy.
- Severe ocular involvement in ENL can lead to globe perforation.
Observation:
- This study investigated a severe case of ocular ENL involving the ciliary body and choroid.
- Immunohistochemistry was performed using CD-3, CD-68, S-100, and CD-20 markers.
- Inflammatory exudates were also analyzed for IgG and IgM presence.
Findings:
- The analysis revealed a significant presence of CD-3-positive T-cells and CD-68-positive macrophages.
- A smaller number of S-100 and CD-20-positive cells were observed.
- IgG and IgM were detected in the inflammatory exudates, confirming an immune complex-mediated process.
Implications:
- This case highlights the potential for severe ocular complications, including globe perforation, from ENL.
- Understanding the cellular infiltrate in ocular ENL is crucial for timely diagnosis and management.
- Early recognition and treatment of ocular ENL are vital to prevent irreversible vision loss in leprosy patients.
