A leprosy patient on multidrug therapy (MDT) develops sudden onset painful erythematous skin nodules with fever, malaise, and leukocytosis. Nerve function is not impaired. What is this reaction and its management?
- A Type 1 (reversal) reaction; treated with systemic corticosteroids
- B Type 2 reaction (erythema nodosum leprosum); treated with thalidomide or prednisolone ✓
- C Lucio phenomenon; treated with clofazimine dose increase
- D Downgrading reaction; MDT should be discontinued
Correct answer: B. Type 2 reaction (erythema nodosum leprosum); treated with thalidomide or prednisolone
Explanation
ENL (Type 2 lepra reaction) occurs in lepromatous and borderline lepromatous leprosy; it is an immune complex (Type III) mediated reaction presenting with tender erythematous nodules, fever, and systemic features without nerve function impairment. Treatment is thalidomide (drug of choice) or prednisolone; MDT is continued. Type 1 (reversal) reaction is a delayed hypersensitivity flare in borderline types and always involves nerve function. Lucio phenomenon is a necrotizing vasculitis in untreated diffuse lepromatous leprosy.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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