Histopathological study of ocular erythema nodosum leprosum
Journal name: World Journal of Pharmaceutical Research
Original article title: Histopathological study of ocular erythema nodosum leprosum
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Ronald N.E.
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Full text available for: Histopathological study of ocular erythema nodosum leprosum
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
Doi: 10.20959/wjpr20173-7694
Copyright (license): WJPR: All rights reserved
Summary of article contents:
Introduction
Leprosy, a chronic granulomatous disease caused by Mycobacterium leprae, presents in several forms, including tuberculoid, borderline, and lepromatous types, depending on the patient's immunological response. Erythema nodosum leprosum (ENL) is an acute inflammatory reaction associated with lepromatous leprosy and represents an exaggerated humoral response. While ENL is known to cause severe systemic reactions, its severity in ocular tissues is infrequently observed. This case report highlights a patient who experienced a severe ocular ENL reaction leading to complications and enucleation, calling attention to a potentially rare but serious ocular manifestation of the condition.
Ocular Complications of Leprosy
The patient in this report had previously refused multi-drug therapy (MDT) after initially starting treatment for lepromatous leprosy. After 17 years of no treatment, she presented with ocular pain and systemic complications. Upon examination, she showed signs of chronic anterior uveitis, including the presence of a conjunctival leproma and an iris granuloma. The case emphasizes that ocular complications resulting from ENL can lead to significant structural damage, such as scleral perforation and iris prolapse, thereby potentially causing blindness. The criticality of immediate follow-up and management for patients on MDT, particularly with lepromatous leprosy, is highlighted.
Histopathological Findings
Histopathological analysis of the enucleated eye revealed significant disruption of normal architecture due to ENL. The findings indicated extensive inflammatory cell infiltration, particularly polymorphs and macrophages filled with M. leprae, across various ocular tissues, including the conjunctiva, cornea, ciliary body, ora serrata, and sclera. Histological staining confirmed the presence of acid-fast bacilli in the ocular tissues, illustrating the degree to which leprosy can invade and compromise ocular integrity. Such results reinforce the importance of histopathological examinations in understanding the extent of damage caused by leprosy-related ENL.
Immunological Response and ENL
The varied immunological response in leprosy patients plays a pivotal role in the severity of their symptoms and disease progression. In this case, the patient exhibited a poor immune response indicative of polar lepromatous leprosy, characterized by an abundance of bacilli and a heightened risk of severe ENL. The report explains that ENL is associated with a significant infiltration of neutrophils and poses risks during treatment, particularly when anti-leprosy medications are administered. This emphasizes the necessity for careful monitoring and management of leprosy patients to mitigate severe immunological reactions like ENL.
Conclusion
This case study serves as a critical reminder to the ophthalmological community regarding the potentially severe ocular complications associated with ENL in leprosy patients. It underscores the importance of prompt diagnosis and intervention in cases of ocular involvement, failure of treatment adherence, and systemic reactions during MDT. As the management of leprosy continues to evolve, increased awareness of ocular ENL can enhance patient outcomes and lead to better-informed treatment strategies. Proper monitoring can ultimately decrease the incidence of severe ocular outcomes and preserve visual function in affected individuals.
FAQ section (important questions/answers):
What causes erythema nodosum leprosum in leprosy patients?
Erythema nodosum leprosum (ENL) is an acute inflammatory response that arises from an exaggerated humoral immune reaction in the course of chronic lepromatous leprosy, often triggered by intercurrent illness or anti-leprosy treatment.
What were the symptoms of the leprosy patient reported?
The 40-year-old female patient experienced pain in her right eye, trophic ulcers in fingers and toes, and exhibited severe systemic and ocular ENL reactions, eventually leading to perforation of the globe at the site of a preexisting leproma.
How does ENL affect ocular tissues in leprosy?
Although severe ENL reactions typically occur systemically, they may also manifest in ocular tissues, leading to complications such as conjunctival leproma, scleral perforation, and severe inflammation in eye structures including the cornea and ciliary body.
What histopathological findings were observed in the case study?
Histopathology revealed infiltration of polymorphs and macrophages filled with acid-fast bacilli in ocular tissues, such as the conjunctiva and cornea, alongside disruption of normal eye structure and presence of inflammatory cells confirming ocular ENL.
What treatment led to ocular complications in this case?
The patient, after starting multi-drug therapy for leprosy, developed severe ocular ENL reactions, which escalated to riskier conditions such as scleral perforation despite being administered steroids and standard MDT.
How does the immune response impact leprosy progression?
The progression of leprosy is heavily influenced by the patient's immune response. An anergic immune status typically seen in lepromatous leprosy leads to the infiltration of bacilli, resulting in severe complications, including systemic reactions like ENL.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Histopathological study of ocular erythema nodosum leprosum”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Leprosy:
Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae. It leads to significant public health concerns, often resulting in severe dermatological and neurological impairments. The relevance of leprosy in medical science lies in its complex pathophysiology, variability in immune response among patients, and the challenges it poses for effective management and treatment strategies.
2) Disease:
A disease refers to a pathological condition of a biological system characterized by dysfunction, distress, or impairment. In the context of leprosy, it highlights the chronic granulomatous nature of the illness, its effects on immune response, and the social stigma associated with infectious diseases, necessitating public health interventions and educational outreach.
3) Science (Scientific):
Science is the systematic study of the structure and behavior of the physical and natural world through observation and experimentation. In the case of ocular erythema nodosum leprosum associated with leprosy, scientific investigation is crucial for understanding the disease mechanisms, treatment options, and histopathological changes that occur, enhancing patient care.
4) Ulcer:
An ulcer is a sore or lesion that develops on the skin or mucous membrane characterized by the loss of tissue. In leprosy, trophic ulcers can result from nerve damage and immune responses. Their presence signifies severe disease progression and complicates treatment, making understanding ulcers pivotal in leprosy management.
5) Blood:
Blood serves as a vital component in the human circulatory system, transporting oxygen, nutrients, and immune cells. In the context of leprosy, changes in blood parameters, including the presence of inflammatory markers and the infiltration of neutrophils and macrophages, are indicative of the disease severity and immune reaction, influencing treatment decisions.
6) Pain:
Pain is a complex sensation that indicates tissue damage or disease and serves as a critical symptom in clinical diagnosis. In leprosy, patients may experience intense pain linked to nerve damage and complications such as erythema nodosum leprosum. Understanding pain mechanisms is essential for effective symptom management and improving quality of life.
7) Study (Studying):
A study involves systematic investigation aimed at acquiring new knowledge or validating existing theories. In this text, a histopathological study is essential for exploring the ocular complications of leprosy, thereby enriching the understanding of disease manifestations and guiding treatment approaches in similar clinical scenarios.
8) Post:
The term 'post' typically refers to something occurring after a particular event or process. In the context of leprosy treatment, 'post-therapeutic' indicates complications that arise following medical interventions, underlining the necessity of monitoring for adverse effects during and after treatment regimens to ensure patient safety.
9) Drug:
A drug is any substance used to diagnose, cure, treat, or prevent disease. In the treatment of leprosy, multi-drug therapy is essential for managing the infection effectively. Understanding drug interactions and their impact on the immune response is vital for achieving favorable treatment outcomes in patients.
10) Perception:
Perception refers to the process of interpreting sensory information and is pivotal in understanding patient experiences, especially in diseases like leprosy that carry significant stigma. Perception influences patient compliance to treatment, perceptions of symptoms, and overall mental health, making its study crucial in designing holistic care strategies.
11) Discussion:
Discussion involves the exchange of ideas and arguments about a particular topic. In a clinical context, discussions among healthcare professionals regarding leprosy cases are essential for information sharing, enhancing treatment strategies, and understanding complex reactions, ultimately benefiting patient care and advancing medical knowledge in infectious diseases.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Histopathological study of ocular erythema nodosum leprosum’. Further sources in the context of Science might help you critically compare this page with similair documents:
Lepromatous leprosy, Clinical diagnosis, Multi-drug therapy, Histopathological study, Inflammatory cells, Humoral Response, Erythema nodosum leprosum, Acid-fast bacilli, Anterior chamber.