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Leprosy Ocular Erythema nodosum leprosum

S.R. Rathinam FAMS PhD Uveitis service Aravind Eye Hospital Madurai. Leprosy Ocular Erythema nodosum leprosum. History. 45 year old male patient with lepromatous leprosy he was advised treatment several times, but because of

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Leprosy Ocular Erythema nodosum leprosum

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  1. S.R. Rathinam FAMS PhD Uveitis service Aravind Eye Hospital Madurai. LeprosyOcular Erythema nodosum leprosum

  2. History • 45 year old male patient with lepromatous leprosy • he was advised treatment several times, but because of • recurrent ENL reaction, patient never took proper treatment.

  3. First Examination • OS: leproma with hypopyon • aqueous tap, staining for Mycobacterium lepra + • hypopyon is reported but very rare in leprosy

  4. Treatment • Standard multi drug anti leprosy treatment • 20 mg oral steroids • 600 mg Rifampicin and 300 mg Clofazimine on day 1 of every month • 100 mg Dapsone daily and • 50 mg Clofazimine for 12-24 months

  5. Follow up - Day 7 • developed very severe type 2 reactions, • experienced fever, malaise, and polyarthralgia as well as an abrupt onset of numerous tender, erythematous nodules over the face, extremities and over the trunk. • This is termed erythema nodosum leprum (ENL) and tends to occur • with poor cellular immunity but strong humoral immunity to M. leprae, • more specifically in patients with high bacillary load

  6. Follow up – Day 7 • severe ocular ENL resulted in ocular perforation • because of severe pain the globe was enucleated • histopathological staining

  7. Histopathology • limbal region LE • Polymorphonuclear cells in ENL

  8. Ciliary body ENL

  9. POLYMORPHS IN ENL

  10. Treatment Options • Corticosteroids are highly useful for type 1 and type 2 reactions, but • Thalidomide is the most effective agent to treat severe forms of type 2 reactions • Thalidomide was not available freely but would have helped this patient

  11. Uveitis was found in 56% In HPE Clinically 5-6 %

  12. Type III Hypersensitivity • Erythema nodosum leprosum (ENL) is induced in a Type 2 lepra reaction • Type 2 lepra reactions are acute inflammatory complications that often present as medical emergencies during the chronic course of treated or untreated Hansen's disease

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