Mahajan Vikram K, Abhinav C, Mehta Karaninder S, Chauhan Pushpinder S
Lepr Rev. 2014 Dec;85(4):322-7.
Erythema nodosum leprosum (ENL) lesions may uncommonly develop ulceration, necrosis, pustulation or bullae. This 60 year-old female was hospitalised with previously undiagnosed multibacillary (BL) leprosy and Sweet's syndrome-like ENL, a presentation that is rarely reported. In addition to skin lesions simulating Sweet's syndrome, she had anaemia, elevated ESR, and a peripheral leucocytosis with neutrophilia, the laboratory features of Sweet's syndrome. The final diagnosis was made from chronic iridocyclitis, presence of lepra bacilli in slit-skin smears, and histology. The pathogenesis of Sweet's-like ENL remains conjectural. In Sweet's syndrome a complex interplay of various cytokines leading to an abundance of pro- inflammatory cytokines in the target tissues has been postulated to initiate an abnormal tissue response to certain antigens; such findings may eventually explain these uncommon lepra reactions as well.
麻风结节性红斑（ENL）病变很少会出现溃疡、坏死、脓疱或大疱。这位60岁女性因之前未确诊的多菌型（BL）麻风及类Sweet综合征的ENL住院，这种表现很少见。除了有类似Sweet综合征的皮肤病变外，她还伴有贫血、血沉升高以及外周血白细胞增多伴中性粒细胞增多，这些都是Sweet综合征的实验室特征。最终诊断依据慢性虹膜睫状体炎、皮肤切片涂片发现麻风杆菌以及组织学检查做出。类Sweet综合征的ENL发病机制仍属推测。在Sweet综合征中，据推测各种细胞因子之间复杂的相互作用导致靶组织中促炎细胞因子大量存在，从而引发对某些抗原的异常组织反应；这些发现最终或许也能解释这些不常见的麻风反应。
