01657nas a2200169   4500000000100000008004100001100001500042700001200057700001300069700001100082700001400093245008900107300001200196490000700208520125800215022001401473       2015                            d1 aBarman K D1 aMadan A1 aGarg V K1 aGoel K1 aKhurana N00aUnusual Presentation of Necrotic Erythema Nodosum Leprosum on Scalp : A Case Report.  a23 - 260 v873 a<p><strong>Editor's Abstract</strong>:</p>

<p>Lepra reactions are acute episodes occurring during the disease process of leprosy and are of 2 types: type 1 or reversal reaction and type 2 reaction or erythema odosumleprosum (ENL). In the episodes of lepra reaction several parts are affected including face and extremities like oral cavity. In the present case report we reported a rare case of lepromatous leprosy with necrotic ENL involving scalp apart from the usual sites. A 58 year old married male presented to us with complaints of spontaneous onset, recurrent eruption of multiple reddish raised painful lesions. Biopsy from the infiltrated skin over the back showed atrophic epidermis, free Grenz zone, diffuse and periadnexal macrophage granulomas with predominant mononuclear infiltrate, appandageal atrophy, fibrosis around the neural structures and leukocytoclastic vasculitis. Fites stain showed strong positivity for M. leprae. His routine blood investigations showed anemia (Hb = 7.8 gm%), neutrophil leukocytosis (TLC = 17,600, DLC = P66L28M4E2) and raised ESR (80 mm in the first hour). These bullous and necrotic lesions in leprosy may be a manifestation of severe type II reactions in patients with very high bacillary load.</p>
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