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Erythema Nodosum Leprosum in a General Hospital

Erythema Nodosum Leprosum in a General Hospital Abstract • We report 32 patients with erythema nodosum leprosum (ENL). Twenty-two patients developed ENL before beginning chemotherapy. The recognition that ENL in the absence of chemotherapy is not an uncommon event is of importance, not simply as a fact in and of itself, but because this observation raises provocative questions when placed in the context of current ideas concerning ENL. ENL should be regarded as a manifestation of leprosy, not necessarily as a complication of its therapy. (Arch Dermatol 111:1575-1580, 1975) References 1. Browne SG: Erythema nosodum in leprosy . J Chronic Dis 16:23-30, 1963.Crossref 2. Pettit JHS, Waters MFR: The etiology of erythema nodosum leprosum . Int J Lepr 35:1-10, 1967. 3. Canizares O, Costello M, Gigli I: Erythema nodosum type of lepra reaction . Arch Dermatol 85:29-40, 1962.Crossref 4. Guinto RS, Tolentino JG, Mabalay MC: Observations on erythema nodosum leprosum . Int J Lepr 31:81-94, 1963. 5. Job CK, Gude S, Macaden VP: Erythema nodosum leprosum: A clinico-pathologic study . Int J Lepr 32:177-184, 1964. 6. Vargas S: Tratamiento actual de la reaccion leprosa por talidomida . Rev Mex Dermatol 15:142-154, 1971. 7. Pepler WJ, Kooij R, Marshall J: The histopathology of acute panniculitis nodosa leprosa (erythema nodosum leprosum) . Int J Lepr 23:53-60, 1955. 8. Ridley DS: Reactions in leprosy . Lepr Rev 40:77-81, 1969. 9. Sheskin J, Convit J: Results of a double blind study of the influence of thalidomide on the lepra reaction . Int J Lepr 37:135-146, 1969. 10. Hastings RC, Trautman JR, Enna CD: Thalidomide in the treatment of erythema nodosum leprosum . Clin Pharmacol Ther 11:481-487, 1970. 11. Ridley DS, Jopling WH: Classification of leprosy according to immunity: A five-group system . Int J Lepr 34:255-273, 1966. 12. Ridley DS, Waters MFR: Significance of variations within the lepromatous group . Lepr Rev 40:143-152, 1969. 13. Rea TH, Levan NE: The concordance of tuberculin responses with the presence or absence of skin ulcerations in lepromatous leprosy . Int J Lepr 42:137-138, 1974. 14. Rea TH, Nies K, Quismorio F, et al: T-cell/B-cell ratios and autoantibodies in lepromatous leprosy . Clin Res 22:332, 1974. 15. Levy L, Fasal P, Levan NE, et al: Treatment of erythema nodosum leprosum with thalidomide . Lancet 2:324-325, 1973.Crossref 16. Moschella SL: The lepra reaction with necrotizing skin lesions . Arch Dermatol 95:565-575, 1967.Crossref 17. Arnold HL, Fasal P: Clinical pattern , in Leprosy, Diagnosis and Management . Springfield, Ill, Charles C Thomas, Publisher, 1973, pp 52-53. 18. Godal T, Pearson JMH, Ross WF: Erythema nodosum leprosum in the absence of chemotherapy . Lancet 1:880, 1973.Crossref 19. Rea TH, Levan NE, Schweitzer RE: Erythema nodosum leprosum in the absence of chemotherapy: A role for cell-mediated immunity . Lancet 2:1252, 1972.Crossref 20. Drutz DJ, Gutman RA: Renal manifestations of leprosy: Glomerulonephritis, a complication of erythema nodosum leprosum . Am J Trop Med Hyg 22:496-502, 1973. 21. Waldorf DS, Sheagren JN, Trautman JR: Impaired delayed hypersensitivity in patients with lepromatous leprosy . Lancet 2:773-777, 1966.Crossref 22. Turk JL, Waters MFR: Cell-mediated immunity in patients with leprosy . Lancet 2:243-246, 1969.Crossref 23. Wemambu SNC, Turk JL, Waters MFR, et al: Erythema nodosum leprosum: A clinical manifestation of the Arthus phenomenon . Lancet 2:933-935, 1969.Crossref 24. Waters MFR, Turk JL, Wemambu SNC: Mechanisms of reactions in leprosy . Int J Lepr 39:417-428, 1971. 25. Moran CJ, Ryder G, Turk JL, et al: Evidence for circulating immune complexes in lepromatous leprosy . Lancet 2:572-573, 1972.Crossref 26. Gelber RH, Epstein WV, Fasal P, et al: Erythema nodosum leprosum: An immune complex disorder . Int J Lepr 40:455-456, 1972. 27. Rojas-Espinosa 0, Mendez-Navarrete I, Estrada-Parra S: Presence of Clq-reactive immune complexes in patients with leprosy . Clin Exp Immunol 12:215-223, 1972. 28. Russell AS, Percy JS: Circulating immune complexes in lepromatous leprosy . Lancet 2:978, 1972.Crossref 29. Gelber RH, Drutz DJ, Epstein WV, et al: Clinical correlates of Clq-precipitating substances in the sera of patients with leprosy . Am J Trop Med Hyg 23:471-475, 1974. 30. Braverman IM, Yen A: Normal skin of patients with leukocytoclastic angiitis . J Invest Dermatol 64:105-122, 1975.Crossref 31. Sams WM Jr, Claman HRV, Kohler PF: Human leucocytoclastic vasculitis: Evidence for an immune complex pathogenesis . Clin Res 22:333, 1974. 32. Ridley DS: A bacteriologic study of erythema nodosum leprosum . Int J Lepr 28:254-266, 1960. 33. Waters MFR, Rees RJW, Sutherland I: Chemotherapeutic trials in leprosy: V. A study of methods used in clinical trials in lepromatous leprosy . Int J Lepr 35:311-335, 1967. 34. Fernandez JMM: Bacteriologia de la reaccion leprosa. Investigacion del Mycobacterium leprae en las lesiones cutaneas de reaccion leprosa . Rev Bras Leprol 4:9-23, 1936. 35. Fakhri O, Hobbs JR: Detection of antibodies which can cooperate with lymphocytes . Lancet 2:403-406, 1972.Crossref 36. Convit J, Pinardi ME, Rodriguez-Ochoa G, et al: Elimination of Mycobacterium leprae subsequent to local in vivo activation of macrophages in lepromatous leprosy by other mycobacteria . Clin Exp Immunol 17:261-265, 1974. 37. Mechanisms of reactions in leprosy, editorial . Lancet 2:280-281, 1972. 38. Okada S, Nakai E, Narita M, et al: Electron microscope study of erythema nodosum leprosum . Int J Lepr 42:33-37, 1974. 39. Browne SG: Erythema nodosum leprosum . Lancet 1:997-998, 1973.Crossref 40. Drutz DJ, Bodel P: Mechanisms of endogenous pyrogen production in patients with leprosy: Why are patients with uncomplicated lepromatous leprosy afebrile? Int J Lepr , to be published. 41. Prabhakaran K, Bapat CV: Effect of diaminodiphenyl sulfone and ICRC bacilli on acid phosphatase of macrophages . Indian J Med Res 54:458-461, 1966. 42. Mayer K, Ley AB: Hemolysis of red cells due to sulfone . Ann Intern Med 72:711-714, 1970.Crossref 43. Seah PP, Fry L, Mazaheri MR, et al: Alternate-pathway complement fixation by IgA in the skin in dermatitis herpetiformis . Lancet 2:175-177, 1973.Crossref 44. Waters MFR, Helmy HS: The relationship of dapsone (DDS) therapy to erythema nodosum leprosum. Is it direct or indirect? Lepr Rev 45:299-307, 1974. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Erythema Nodosum Leprosum in a General Hospital

Archives of Dermatology , Volume 111 (12) – Dec 1, 1975

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1975.01630240031005
Publisher site
See Article on Publisher Site

Abstract

Abstract • We report 32 patients with erythema nodosum leprosum (ENL). Twenty-two patients developed ENL before beginning chemotherapy. The recognition that ENL in the absence of chemotherapy is not an uncommon event is of importance, not simply as a fact in and of itself, but because this observation raises provocative questions when placed in the context of current ideas concerning ENL. ENL should be regarded as a manifestation of leprosy, not necessarily as a complication of its therapy. (Arch Dermatol 111:1575-1580, 1975) References 1. Browne SG: Erythema nosodum in leprosy . J Chronic Dis 16:23-30, 1963.Crossref 2. Pettit JHS, Waters MFR: The etiology of erythema nodosum leprosum . Int J Lepr 35:1-10, 1967. 3. Canizares O, Costello M, Gigli I: Erythema nodosum type of lepra reaction . Arch Dermatol 85:29-40, 1962.Crossref 4. Guinto RS, Tolentino JG, Mabalay MC: Observations on erythema nodosum leprosum . Int J Lepr 31:81-94, 1963. 5. Job CK, Gude S, Macaden VP: Erythema nodosum leprosum: A clinico-pathologic study . Int J Lepr 32:177-184, 1964. 6. Vargas S: Tratamiento actual de la reaccion leprosa por talidomida . Rev Mex Dermatol 15:142-154, 1971. 7. Pepler WJ, Kooij R, Marshall J: The histopathology of acute panniculitis nodosa leprosa (erythema nodosum leprosum) . Int J Lepr 23:53-60, 1955. 8. Ridley DS: Reactions in leprosy . Lepr Rev 40:77-81, 1969. 9. Sheskin J, Convit J: Results of a double blind study of the influence of thalidomide on the lepra reaction . Int J Lepr 37:135-146, 1969. 10. Hastings RC, Trautman JR, Enna CD: Thalidomide in the treatment of erythema nodosum leprosum . Clin Pharmacol Ther 11:481-487, 1970. 11. Ridley DS, Jopling WH: Classification of leprosy according to immunity: A five-group system . Int J Lepr 34:255-273, 1966. 12. Ridley DS, Waters MFR: Significance of variations within the lepromatous group . Lepr Rev 40:143-152, 1969. 13. Rea TH, Levan NE: The concordance of tuberculin responses with the presence or absence of skin ulcerations in lepromatous leprosy . Int J Lepr 42:137-138, 1974. 14. Rea TH, Nies K, Quismorio F, et al: T-cell/B-cell ratios and autoantibodies in lepromatous leprosy . Clin Res 22:332, 1974. 15. Levy L, Fasal P, Levan NE, et al: Treatment of erythema nodosum leprosum with thalidomide . Lancet 2:324-325, 1973.Crossref 16. Moschella SL: The lepra reaction with necrotizing skin lesions . Arch Dermatol 95:565-575, 1967.Crossref 17. Arnold HL, Fasal P: Clinical pattern , in Leprosy, Diagnosis and Management . Springfield, Ill, Charles C Thomas, Publisher, 1973, pp 52-53. 18. Godal T, Pearson JMH, Ross WF: Erythema nodosum leprosum in the absence of chemotherapy . Lancet 1:880, 1973.Crossref 19. Rea TH, Levan NE, Schweitzer RE: Erythema nodosum leprosum in the absence of chemotherapy: A role for cell-mediated immunity . Lancet 2:1252, 1972.Crossref 20. Drutz DJ, Gutman RA: Renal manifestations of leprosy: Glomerulonephritis, a complication of erythema nodosum leprosum . Am J Trop Med Hyg 22:496-502, 1973. 21. Waldorf DS, Sheagren JN, Trautman JR: Impaired delayed hypersensitivity in patients with lepromatous leprosy . Lancet 2:773-777, 1966.Crossref 22. Turk JL, Waters MFR: Cell-mediated immunity in patients with leprosy . Lancet 2:243-246, 1969.Crossref 23. Wemambu SNC, Turk JL, Waters MFR, et al: Erythema nodosum leprosum: A clinical manifestation of the Arthus phenomenon . Lancet 2:933-935, 1969.Crossref 24. Waters MFR, Turk JL, Wemambu SNC: Mechanisms of reactions in leprosy . Int J Lepr 39:417-428, 1971. 25. Moran CJ, Ryder G, Turk JL, et al: Evidence for circulating immune complexes in lepromatous leprosy . Lancet 2:572-573, 1972.Crossref 26. Gelber RH, Epstein WV, Fasal P, et al: Erythema nodosum leprosum: An immune complex disorder . Int J Lepr 40:455-456, 1972. 27. Rojas-Espinosa 0, Mendez-Navarrete I, Estrada-Parra S: Presence of Clq-reactive immune complexes in patients with leprosy . Clin Exp Immunol 12:215-223, 1972. 28. Russell AS, Percy JS: Circulating immune complexes in lepromatous leprosy . Lancet 2:978, 1972.Crossref 29. Gelber RH, Drutz DJ, Epstein WV, et al: Clinical correlates of Clq-precipitating substances in the sera of patients with leprosy . Am J Trop Med Hyg 23:471-475, 1974. 30. Braverman IM, Yen A: Normal skin of patients with leukocytoclastic angiitis . J Invest Dermatol 64:105-122, 1975.Crossref 31. Sams WM Jr, Claman HRV, Kohler PF: Human leucocytoclastic vasculitis: Evidence for an immune complex pathogenesis . Clin Res 22:333, 1974. 32. Ridley DS: A bacteriologic study of erythema nodosum leprosum . Int J Lepr 28:254-266, 1960. 33. Waters MFR, Rees RJW, Sutherland I: Chemotherapeutic trials in leprosy: V. A study of methods used in clinical trials in lepromatous leprosy . Int J Lepr 35:311-335, 1967. 34. Fernandez JMM: Bacteriologia de la reaccion leprosa. Investigacion del Mycobacterium leprae en las lesiones cutaneas de reaccion leprosa . Rev Bras Leprol 4:9-23, 1936. 35. Fakhri O, Hobbs JR: Detection of antibodies which can cooperate with lymphocytes . Lancet 2:403-406, 1972.Crossref 36. Convit J, Pinardi ME, Rodriguez-Ochoa G, et al: Elimination of Mycobacterium leprae subsequent to local in vivo activation of macrophages in lepromatous leprosy by other mycobacteria . Clin Exp Immunol 17:261-265, 1974. 37. Mechanisms of reactions in leprosy, editorial . Lancet 2:280-281, 1972. 38. Okada S, Nakai E, Narita M, et al: Electron microscope study of erythema nodosum leprosum . Int J Lepr 42:33-37, 1974. 39. Browne SG: Erythema nodosum leprosum . Lancet 1:997-998, 1973.Crossref 40. Drutz DJ, Bodel P: Mechanisms of endogenous pyrogen production in patients with leprosy: Why are patients with uncomplicated lepromatous leprosy afebrile? Int J Lepr , to be published. 41. Prabhakaran K, Bapat CV: Effect of diaminodiphenyl sulfone and ICRC bacilli on acid phosphatase of macrophages . Indian J Med Res 54:458-461, 1966. 42. Mayer K, Ley AB: Hemolysis of red cells due to sulfone . Ann Intern Med 72:711-714, 1970.Crossref 43. Seah PP, Fry L, Mazaheri MR, et al: Alternate-pathway complement fixation by IgA in the skin in dermatitis herpetiformis . Lancet 2:175-177, 1973.Crossref 44. Waters MFR, Helmy HS: The relationship of dapsone (DDS) therapy to erythema nodosum leprosum. Is it direct or indirect? Lepr Rev 45:299-307, 1974.

Journal

Archives of DermatologyAmerican Medical Association

Published: Dec 1, 1975

References

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