TYPE 1 LEPRA REACTION MIMICKING BULLOUS FIXED DRUG ERUPTION

Abstract

Leprosy is a chronic infectious disease with varied clinical presentations. Leprosy reactions generally manifest as erythematous edematous tender plaques or evanescent erythematous nodules with or without neuritis. Bullous type of reactions are rare in leprosy. We hereby report a case of borderline tuberculoid leprosy with bullous eruption. A 24 year old male, known case of borderline tuberculoid leprosy who has completed MB MDT after which he continued Dapsone and Rifampicin for another 6 months, now presented with acute onset of fever, malaise, swelling of both feet and painful raised reddish lesions followed by uid lled lesions over the pre existing lesions of leprosy i.e.,on right ear and right sole since 10 days. There is no history of similar episodes. On examination patient looks toxic with bilateral pitting type of pedal edema. Cutaneous examination revealed a single well dened erythematous plaque with vesicles and crusting over pinna and helix of right ear. A single well dened erythematous plaque with central vesicle surrounded by edematous ring noted over medial aspect of right sole. No other skin lesions & mucosal lesions were present. Nikolsky and bulla spread sign was negative. Nerve examination revealed ulnar & common peroneal nerve thickening and tenderness over right side. Routine investigations revealed raised ESR & bilirubin levels. Tzanck smear and slit skin smear was negative. Histopathological examination showed dermal edema with few ill dened granulomas. Based on the above ndings a diagnosis of BT leprosy in Type 1 reaction with bullous eruption was made which is rare after completing MB MDT. However it needs to be differentiated from other causes of bullous eruption