Rijal A, Agrawal S, Agarwalla A, Lakhey M
Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Lepr Rev. 2004 Jun;75(2):177-80.
A patient with lepromatous leprosy, while on WHO multidrug therapy (MDT) for multibacillary disease, was diagnosed as having dapsone syndrome with recurrent episodes of bullous lesions on the lower extremities for 4-5 years. The lesions were associated with high-grade fever. Examination revealed multiple hypopigmented macules on the limbs. Multiple atrophic scars were also found on the buttocks and lower limbs. Bilateral ulnar, radial cutaneous and lateral popliteal nerves were thickened. On day 10 of WHO-MB-MDT he developed a flaccid bulla on the lower leg. Skin slit smear showed a bacterial index (BI) of 3+ and the histopathology was consistent with type II reaction. High dose corticosteroid therapy was started but he continued to have new lesions, and was therefore referred to a centre where thalidomide was available. Clinical response was good and he remained symptom-free after gradual reduction in dosage. ENL should be differentiated from bullous drug reactions, pemphigus vulgaris, bullous pemphigoid and other blistering diseases.
一名瘤型麻风患者在接受世界卫生组织针对多菌型疾病的多药联合化疗（MDT）时，被诊断为氨苯砜综合征，其下肢反复出现大疱性皮损4至5年。这些皮损伴有高热。检查发现四肢有多处色素减退斑。臀部和下肢也有多处萎缩性瘢痕。双侧尺神经、桡神经皮支和腘外侧神经增粗。在接受世界卫生组织多菌型麻风多药联合化疗的第10天，他小腿出现一个松弛性大疱。皮肤刮片涂片显示细菌指数（BI）为3+，组织病理学与Ⅱ型反应一致。开始使用高剂量皮质类固醇治疗，但他仍不断出现新的皮损，因此被转诊至有沙利度胺的中心。临床反应良好，在逐渐减量后他一直无症状。结节性红斑样反应应与大疱性药物反应、寻常型天疱疮、大疱性类天疱疮及其他水疱性疾病相鉴别。
