Reversal reaction with granulomatous vasculities and necrotizing cutaneous lesions

Abstract

A diagnostic of sub-polar lepromatous leprosy was performed in a 49 years old male. He referred having symptoms for 11 years, mainly neurologic, characteristic of leprosy, but the definitive diagnosis was not performed in any of the previous medical evaluations. After 6 months of multidrugtherapy he presented neuritis treated as type 2 reaction. In a last episode the patient presented with fever, malaise and a crop of necrotic lesions, and ulcerations in the limbs, buttocks, back and left ear. The clinical aspect of these lesions was similar to lesions found in Lucio’s phenomenon and Necrotizing Erythema nodosum leprosum. The biopsies showed changes in the superficial microvasculature and necrosis of dermis and epidermis similar to these reactions, but the basic vascular changes were granulomatous vasculitis in the deep dermis and sub-cutis. The clinical and histopathological features were interpreted as type 1 reaction (reversal reaction) with predominant vascular involvement.