Type II lepra reaction: an unusual presentation
Chauhan, S.; D'Cruz, S.; Mohan, H.; Singh, R.; Ram, J.; Sachdev, A.
Dermatology Online Journal 12(1): 18
2006
ISSN/ISBN: 1087-2108 PMID: 16638386 Document Number: 596929
Ulcers with maculo-papular rash are an unusual presenting feature of leprosy. They occur as result of neuropathy, type-2 lepra reaction or Lucio's phenomenon. The hall mark of type-2 reaction is erythema nodosum. Very rarely it manifests as ulcerative skin lesions. We describe one such unusual case of a young male who presented with multiple ulcers and maculo-papular rash over the legs, chest and abdomen. In addition to this, he had fever, heart murmur, pulmonary infiltrates, neuropathy, and deranged liver function. A clinical differential diagnosis of infective endocarditis and systemic nectrozing vasculitis was made. Skin biopsy showed dense inflammation with lepra bacilli consistent with type-2 lepra reaction.