Chauhan S, D'Cruz S, Mohan H, Singh R, Ram J, Sachdev A
Department of Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Dermatol Online J. 2006 Jan 27;12(1):18.
Ulcers with maculo-papular rash are an unusual presenting feature of leprosy. They occur as result of neuropathy, type-2 lepra reaction or Lucio's phenomenon. The hall mark of type-2 reaction is erythema nodosum. Very rarely it manifests as ulcerative skin lesions. We describe one such unusual case of a young male who presented with multiple ulcers and maculo-papular rash over the legs, chest and abdomen. In addition to this, he had fever, heart murmur, pulmonary infiltrates, neuropathy, and deranged liver function. A clinical differential diagnosis of infective endocarditis and systemic nectrozing vasculitis was made. Skin biopsy showed dense inflammation with lepra bacilli consistent with type-2 lepra reaction.
伴有斑丘疹的溃疡是麻风病一种不常见的表现特征。它们是由神经病变、2型麻风反应或卢西奥现象引起的。2型反应的标志性特征是结节性红斑。极罕见情况下，它表现为溃疡性皮肤病变。我们描述了这样一例不寻常的病例，一名年轻男性患者，其腿部、胸部和腹部出现多处溃疡及斑丘疹。除此之外，他还有发热、心脏杂音、肺部浸润、神经病变及肝功能紊乱。临床鉴别诊断为感染性心内膜炎和系统性坏死性血管炎。皮肤活检显示有密集炎症及麻风杆菌，符合2型麻风反应。
