Liver lesions in reactional states in leprosy

Liver biopsy was done in 21 adult patients of leprosy in acute reaction. They included 10 of lepromatous leprosy, seven of tuberculoid leprosy and four of dimorphic leprosy. Except for a single case of tuberculoid leprosy all showed granulomatous lesions of varying sizes and frequency, in the liver. The lesions appeared to be unique for reaction and immunologically-based. The sequence of events appeared to be: (1) Immunologically-mediated alteration of Kupffer cells with adhesion of lymphocytes and polymorphounuclear leucocytes (2) Small granulomas of proliferating Kupffer cells, lymphocytes and polymorphs. (3) In some cases. formation of larger granulomas with breaking down of reticulin and liver cell necrosis.