Abstract and Introduction
Introduction: LP is an uncommon reaction characterized by outbreaks of erythematous, painful, slightly infiltrated macules and hemorrhagic bullae that progress to ulceration that occurs in patients with Lucio leprosy and lepromatous leprosy; it can be considered a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs, and pregnancy.
Case Report: A 17-year-old female presented with fever, tachycardia, adynamia, extensive hyperchromic and purplish macular lesions, erythematous plaques, multiple blisters with serohematic content, and necrotic exulcerations and ulcers on the lower and upper limbs, ears, nose, palms, and soles. Past medical history included leprosy and a first trimester miscarriage. The patient was diagnosed with borderline lepromatous leprosy in reactional state (ie, LP) and MDT was restarted in association with systemic corticosteroid and pentoxifylline. Local therapy was performed with cleansing solution (0.9% sodium chloride), dressing with silver sulfadiazine ointment, and surgical debridement of the necrotic lesions.
Conclusion: LP is a rare manifestation that may be fatal because of considerable inflammatory activity and the extent and severity of dermatologic lesions. Pregnancy is strongly associated with exacerbation of symptoms. Debridement is required to excise nonviable tissue and promote wound healing.
Leprosy is a neglected tropical disease that, despite considerable efforts, remains a major healthcare burden in many underdeveloped and developing countries. In the year of 2017, 80.2% of the new cases reported globally were located in 3 countries: India, Brazil, and Indonesia. In the Americas region, Brazil is the country with the highest burden, accounting for 92.3% of new leprosy cases. Between 2014 and 2018, the average incidence rate in Brazil was 13.64 new cases per 100000 inhabitants.
Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae that primarily affects the skin and peripheral nerves. Contrary to popular belief, leprosy is not highly contagious, and treatment is readily available.[1,3] Through awareness and early medical intervention, significant reduction in disability related to the eyes, hands, and feet is possible. Relapses tend to be rare; however, any damage caused by neuropathy is irreversible and may require lifelong care. Kamath et al stated that: "immunologic reactions are an important aspect of leprosy that markedly affect the disease course and associated disability. The reactions may occur before, during, or after treatment with MDT. Reversal reaction (type 1), erythema nodosum leprosum (type 2), and LP are the 3 leprosy reactions, and they most commonly occur in patients with the lepromatous and borderline categories of the disease." Although Brazil has the world's second highest incidence of leprosy,[1,2] few cases of LP are reported in the Brazilian literature.
The case of an adolescent treated for LP is presented herein. Written informed consent for publication of this report and accompanying images was obtained from the patient's parents.
Wounds. 2022;34(12):E147-E151. © 2022 HMP Communications, LLC