A case series of sweet syndrome like erythema nodosum leprosum at tertiary care centrein Western India

Abstract

Leprosy is a chronic disease caused by Mycobacterium Leprae, mainly affecting skin and nerves. Chronic course of leprosy may be interrupted by acute inflammatory conditions called lepra reactions. Type 2 reaction (Erythema Nododsum Leprosum/ENL) classically presents as crops of multiple tender, evanescent nodules. Several pleomorphic variants of ENL has been described in the literature such as erythema necroticans, sweet syndrome–like, erythema multiforme like, livedoreticularis like and bullous ENL. Identification of unusual cutaneous features of ENL are of paramount importance ,which poses a diagnostic challenge. The study aimed at identifying the sweet syndrome like ENL, their clinical and histopathological feautures. This is a retrospective study done at a tertiary care centre of western India. There were eight cases of sweet syndrome like ENL. Out of 8 patients, 6 had lepromatous leprosy, 1 each of borderline lepromatous leprosy and histoid leprosy. All patients had a sudden onset of painful erythematous oedematous plaques and nodules with pseudovesiculation. The study emphasizes the importance of early diagnosis and prompt treatment of atypical ENL reactions. WHO Global Leprosy strategy 2030 also emphasizes on early detection to prevent deformities and disabilities, and thereby improving the quality of life of the patients living with the leprosy.