Erythema Nodosum Leprosum in Lepromatous Leprosy Patient with hypochrome microcytic anemia and reactive HbsAg

Dewi Taslya Muslimin, Muhammad Dali Amiruddin, Sri Vitayani Muchtar

Department of Dermato-Venereology, Medical Faculty, Hasanuddin University/ Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Abstract Background Erythema nodosum leprosum (ENL) is a manifestation of type-2 lepra reaction, which is in turn a Coomb and Gell Type III hypersensitivity reaction. This reaction characterized by brightly red, raised, tender nodules and plaques of varying sizes associated with fever and other constitutional symptoms. ENL can occur in leprosy patients before treatment, while treatment and after the treatment of multidrug therapy (MDT), which can be exacerbated by the presence of other infections in people. Methodology We describe a 71-year-old man with erythematous nodules and joint pain. He had anesthesia sense of touch, pain and temperature on skin lesion, also thickening of ulnar nerve. Slit skin smear showed a bacterial index (BI) of 3+ and the histopathology was lepromatous leprosy with ENL reaction. Laboratory results found hypochrome microcytic anemia and reactive HBsAg. Result Treatment with methylprednisolone (tapering off) and neuroroborantia gives good results. Conclusions This report highlights reactive HbsAg and hypochrome microcytic anemia as precipitating factors for ENL reaction in lepromatous leprosy Keywords: anemia, ENL, HBsAg, lepromatous leprosy, methylprednisolone