Type 2 lepra reaction in Adult
Patients present with sudden onset crops of painful, tender, and erythematous subcutaneous nodules that may subsequently ulcerate. The lesions are common on the face and extensor surfaces of the upper and lower extremities. In addition, there may be systemic signs such as fever, malaise, arthralgias, and myalgias. Other affected organs may include the eyes, kidneys, testes, and lymph nodes. Type 2 reactions are caused by immune complex formation and deposition. They typically are seen in patients with borderline lepromatous or polar lepromatous disease. Other risk factors for type 2 reactions include hormonal changes in women that come with puberty, pregnancy, and lactation. Reactions may last from days to weeks; they may recur or persist over months.
Prompt diagnosis and treatment of lepra reactions is necessary to prevent significant neurologic morbidity and disability.
B92 – Sequelae of leprosy
240410002 – Type 2 lepra reaction
Differential Diagnosis & Pitfalls
- Erythema nodosum – Typically affects the lower legs; lesions are less widespread than in type 2 lepra reaction.
- Acute febrile neutrophilic dermatosis (Sweet syndrome)
- Rheumatoid neutrophilic dermatosis
- Cutaneous polyarteritis nodosa
- Lucio phenomenon
- Diffuse cutaneous leishmaniasis – In endemic regions (see cutaneous leishmaniasis).