Pentoxifylline in reactions in leprosy

A study was conducted to assess the response of reactions in leprosy to pentoxifylline therapy. Ten cases were studied; 8 cases had type 2 reaction and 2 cases had type 1 reaction. Pentoxifylline was given orally 400 mg three times daily. In patients with type 2 reaction, good response was observed within one week. There was near complete regression of ENL lesions within one month. Cases with type 1 reaction did not respond to pentoxifylline.     

Advances in the treatment of reactions in leprosy

Morbidity in leprosy is almost always due to reactions. Similarly, to a great extent, deformities in leprosy are the consequence of reactions occurring both in borderline patients (type 1 or reversal reactions) and in lepromatous patients (type 2 or ENL reactions). Over the last three decades, work has centred around finding who are prone to getting the reactions, identifying the risk factors and improving the management of reactions in order to alleviate quickly the suffering and prevent and reverse nerve damage consequent to reactions. Though several new drugs have been tried and found somewhat useful, corticosteroids and thalidomide continue to be the mainstay in the management of leprosy reactions. A brief review of the current understanding is presented.     

Ocular changes in reactions in leprosy

A study of ocular changes in reactions in leprosy was undertaken to assign these changes, their proper place in the wide spectrum of ocular morbidity in leprosy. 76.1% of eyes of Type I reaction and 89.7% of eyes with Type II reaction showed some ocular involvement. Corneal hypoaesthesia, superficial punctate keratitis, a decrease of corneal film break up time (BUT), prominent corneal nerves, pigment on the endothelium of the cornea and a pigmented trabecular meshwork were the common ocular findings. The incidence of iridocyclitis in Type II reactions was low (8.1%). The significance of the ocular involvement in reactions in leprosy and the pathogenesis of iridocyclitis in Type II reactions is discussed.     

Some unusual type 2 reactions in leprosy

Background Type 2 reactions with lepromatous leprosy (LL) not occurring during multi‐drug therapy (MDT) have been reported. Methods Three patients have been described, each representing a prototype, the first presenting as bullous erythema nodosum leprosum (ENL), second with ENL erupting after treatment for co‐existing pulmonary tuberculosis and resembling immune reconstitution inflammatory syndrome, and a third patient with recurrent Sweets‐syndrome like presentation who had taken incomplete MDT in the past for leprosy. In all, the diagnosis was established by demonstration of acid‐fast bacilli (AFB) on slit‐skin smears (SSS) and histopathology. Results & Conclusion The fact that reactions can occur in patients with clinically inapparent LL, who are more likely to present in general hospitals, has been reemphasized to enhance awareness among physicians. First presentation of leprosy as ENL is probably precipitated by common antibiotics taken for other illnesses. Since reactional episodes can occur before, during and after MDT for leprosy and the clinical picture is not specific to any of them, it is important to ascertain the status of anti‐leprosy therapy during these episodes and treat them accordingly.     

Observations on T-cell sub-populations in type II reactions

15 cases each of Type II Reaction, LL and TT Leprosy and 50 endemic controls were studied for phenotypic markers T2, T4 and T8 by 2 step immunoperoxidase technique. There was statistically significant increase in T4 (helper) cells in Type II Reaction. There was also a decrease in T8 cells but this was not statistically significant.     

Positive Mitsuda lepromin reactions in long-term treated lepromatous leprosy

Twenty-four lepromatous (LL) patients, treated for 22 to 40 years with chemotherapy, including sulphones and with multidrug therapy, were tested with standard Wade-Mitsuda lepromin. Thirteen gave weak positive (3-4 mm) Mitsuda reactions, confirmed histologically in the ten whose reactions were biopsied. Six of the eleven negative reactors were partly accounted for by a history of relapse, and two others had probably taken dapsone irregularly. Eleven control LL patients, treated for less than 20 years, were uniformly lepromin negative. Spontaneous lepromin conversion appears to occur around 24 years after commencing successful chemotherapy. The late Mitsuda conversions are attributed to delayed clearance of the reservoir of bacterial antigen, but a poor correlation between Mitsuda and Fernandez positivity is not explained.     

Serum immune complexes in erythema nodosum leprosum reactions of leprosy

Serum estimations of immunoglobulins, complement components and their presence in circulating immune complexes were carried out in 39 Lepromatous, 44 ENL and 22 Post ENL leprosy patients. Serum IgG, IgA, IgM, C3 and C4 levels were determined by single radial immunodiffusion. Serum immune complexes were precipitated with Polyethylene Glycol (PEG) and IgG, IgA, IgM, C3 and C4 were estimated by single radial immunodiffusion and expressed as % of precipitation of their serum level. Decreased IgG, IgM; increased IgA and C3; and no change in C4 levels are observed in ENL than Lepromatous and Post ENL patients. However, a gradual insignificant reduction of IgG, IgA, and IgM was found from Lepromatous to ENL and Post ENL patients in the PEG-precipitates. Similarly, C3 and C4 was found reduced insignificantly in ENL than Lepromatous and Post ENL patients. The significance of these estimations in relation to immune status of ENL reactions are discussed.