Sharath Savitha, Ahuja Arvind, Sinha Surabhi, Sardana Kabir
Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.
Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.
Am J Trop Med Hyg. 2025 Feb 25;112(5):1081-1086. doi: 10.4269/ajtmh.23-0426. Print 2025 May 7.
Nerve destruction is central to the pathogenesis and clinical manifestation of leprosy reactions (LRs). However, pathological changes in dermal nerves in LRs have not been clearly elucidated. Hematoxylin and eosin (H&E) staining may fail to accurately identify fragmented nerves, and special stains may be required. We recruited 56 patients with clinically diagnosed LRs as cases and 30 patients with nonreactional leprosy as controls. Number and level of nerves, nerve edema, relation of granulomas to nerves, perineuritis, pattern of nerve involvement, and quantification of each nerve pattern were noted on H&E stain and S-100 immunostain on skin biopsy sections. Most of the cases were borderline tuberculoid (BT; 32.8%) and lepromatous leprosy (32.8%) types, whereas most controls were classified as BT (44.8%). We found greater dermal nerve infiltration, fragmentation, and destruction during reactions when compared with nonreactional leprosy (fragmented nerves on S-100: P <0.0001). Nerve fragmentation (P = 0.037), subcutaneous nerve involvement (P = 0.014), and severe nerve edema (P = 0.0005) were higher in type 2 reaction (T2R) compared with type 1 reaction (T1R; on S-100), mostly attributed to the higher number of severe T2Rs (n = 23/25) among our cases. Intact nerves were higher in downgrading T1R compared with upgrading T1R (P = 0.038 on H&E and P = 0.004 on S-100). Thus, the identification and quantification of different patterns of nerves using special stains, such as S-100, may shed more light on nerve fiber involvement and destruction in LRs and may help us predict the prognosis of such cases.
神经破坏是麻风反应（LRs）发病机制和临床表现的核心。然而，LRs中真皮神经的病理变化尚未得到明确阐明。苏木精和伊红（H&E）染色可能无法准确识别断裂的神经，可能需要特殊染色。我们招募了56例临床诊断为LRs的患者作为病例组，30例无反应性麻风患者作为对照组。在皮肤活检切片上，通过H&E染色和S-100免疫染色观察神经的数量和层次、神经水肿、肉芽肿与神经的关系、神经炎、神经受累模式以及每种神经模式的量化。大多数病例为界线类偏结核样型（BT；32.8%）和瘤型麻风（32.8%），而大多数对照组被归类为BT（44.8%）。我们发现，与无反应性麻风相比，反应期真皮神经浸润、断裂和破坏更严重（S-100染色显示断裂神经：P<0.0001）。与1型反应（T1R；S-100染色）相比，2型反应（T2R）的神经断裂（P = 0.037）、皮下神经受累（P = 0.014）和严重神经水肿（P = 0.0005）更严重，这主要归因于我们病例组中严重T2R的数量较多（n = 23/25）。与升级的T1R相比，降级的T1R中完整神经更多（H&E染色P = 0.038，S-100染色P = 0.004）。因此，使用特殊染色如S-100对不同神经模式进行识别和量化，可能有助于更深入了解LRs中神经纤维的受累和破坏情况，并可能帮助我们预测此类病例的预后。
