Clinico-pathological overview of lepra reactions in the era of leprosy elimination

Abstract

Context: Lepra reactions are a chronic debilitating public health problem. It causes nerve damage, loss of limbs and deformities. They may occur during the natural course of the disease, throughout treatment or after it. Wide variations in clinical presentation make histopathology an important tool. There needs to be more inclusive histologic criteria for diagnosing lepra reactions. Aims: This study aims to analyse clinical diagnosis with histopathological findings, different histological types of lepra reactions and their changes, and the frequency of mycobacterial positive cases in lepra reaction cases using Modified Fite’s stain Settings and Design: Observational cross-sectional study Methods and Material: The clinically suspected cases of lepra reactions, irrespective of age and sex attending OPD in Department of Dermatology, at North Bengal Medical College and Hospital were biopsied. Statistical analysis used: Number and percentages were analysed in Microsoft excel. Results: Histopathological features based on the type of infiltrate predominance of neutrophilic infiltration, vasculitis, and supporting features like vasculitis, neutrophilic abscess formation within the dermis will help in clinching a diagnosis of ENL, while a predominant lymphocytic infiltrate, intra granuloma oedema along with presence of giant cells and oedema of papillary dermis will be commoner in T1LR. Conclusions: Histopathology along with clinical findings will help in proper identification of atypical cases. Key-words: Lepra reaction, ENL, Type 1 lepra reaction, Type 2 lepra reaction