We report a case of erythema nodosum leprosum with various systemic manifestations
developed in boderline-lepromatous patient after delivery. A 24-year-old postpartum
female presented with several plaques and multiple tender nodules of her trunk and
arms, concomitantly with high fever, edema of face, hands, and feet, neuralgia of both
limbs, and polyarthralgia Skin slit smear for acid-fast bacilli showed 3+BI
and 10% MI, and lepromin test was negative. Histopathologic examination reveraled
several patch granulomas composed of lymphocytes, epitheliold cells, and foamy
macrophages in the dermis of skin biopsy section, and nerve biopsy section showed
endoneurial disorganization and perineurial thickening with lymphocytes and epithelioid
cells infiltration and fibrosis. Both of the skin and nerve sections revealed many
acid-fast bacilli on Fite-Farraco stain. DNA-PCR with DNA extracts from skin biopsy
specimen revealed M. leprae specific 360 bp PCR products. Abdominal sonography
revealed hepatosplenomegaly and bone scan showed diffuse hyperactivity in periarticular
joint space. Electromyography showed polyneuropathy with decreased motor and sensory
conduction velocity.
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