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LEPRAE REACTION TYPE ENL

By Latifah Husna binti Zulkafli C11111871Satria Bayu Pratama C11111142

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GROUP

• Latifah Husna binti Zulkafli (C11111871)• Satria Bayu Pratama (C11111142)

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DEFINITION

• The chronic granulomatous disease is occasionally complicated by acute exacerbational states termed as Lepra Reactions.• Leprosy reaction can develop at any time• Onset of the disease : • before starting the treatment• During treatment• After completion the treatment

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RISK FACTOR

•Patient is in poor state of health•Pregnancy•After immunisation•Physical and metal stress• Infection•Poor nutrition status

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CAUSAL OF LEPRAE REACTION

•Cause: occurs as a result of increased activity of the body’s immune system, particularly cell mediated immune response fighting the leprosy bacillus or remnants of dead bacilli.

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Signs Type 1 type 2

Type 1 reaction Cell mediated Delayed hypersensitivity

Antigen-antibody (immune complex)reaction

Inflammation of skin Reddish, swollen, warm, painful/ tender

red, painful, tender,cutaneous/subcutaneous nodules. ENL may appear comonly on face, extensor surfaces of arms and legs

Nerve involvement May be enlarged, tender and painful

Nerves may be affected

General conditions Good, with little or no fever/ other constitutional symptoms

Poor, with prominent fever and general malaise

Eye involvement Weakness of eyelid muscles leading to incomplete closure

may occur

Internal eye disease (iritis, iridocyclitis) occurs,

lepromatous nodules are seen

Other organs/ tissue Not affected Maybe affected

CLINICAL SIGN

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CASE REPORT

IDENTIFICATION• Name : Ny J• Age : 16• Gender : Woman• Status: Unmarried• Religion : Islam• Race : Indonesia• Address : Bulukumba

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• Chief complaint Patient complaint of painfull at joint and nodul can be seen all over her body.• Additional complaint• Fatigue and easily get tired.• History of disease• Non of her family got the same symptom• Pathway of disease • One year ago, patient complaint of having nodul and itching at her

hand. She also had small discoloured patches at her upper thigh. Then the nodul burst and became painful. She also complaint of having painful joint.

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PHYSICAL EXAMINATION

Generalise condition• General condition: Severe• Conciousness: kompos mentis• Blood pressure: 110/20 mmHg• Heart rate: 70x/minute• Temperature: 37 ‘C• Breathing: 20x/minute• Height: 140• Weight: 40

Specific condition• Head: Normochepali• Eye (sclera/icterus): (-)• ENT: Normal • Neck: Normal• Thorac: Normal• Abdomen: Normal• Extremity : Normal• Localize pain: (+) neck• Anaesthesi: (+) leg

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DERMATOLOGICAL STATUS

• Nodul erythematous• Ulcus• Di regio punggung, tangan, ektremitas inferior, ektremitas superior

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PHOTO

ULCUS

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ULCUS

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REGIO ABDOMINAL

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REGIO EKTREMITAS INFERIOR

ULCUS

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ULCUS

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Type 1 reaction

Mild type 1 Severe type 1

• Occurs in some of pre-existing skin lesions only• Erythema and swelling of

skin lesions without ulceration• Nerves are not affected• No constitutional

symptoms• No edema of hands and

feet

• Red, painful, inflamed skin lesions with ulceration• Pain/ tenderness in one or

more nerves with/out loss of nerve function• Constitutional symptoms• Marked edema of hands,

feet or face• Increased/ new muscle

weakness noticed (motor loss)

DIAGNOSIS

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Type 2 reaction

Mild type 2 Severe type 2• Intermittent crops of few ENL• Nerves are not affected• Mild fever (less than 100°F) may

or may not be present• No other organs involved

• Red, painful, multiple/ innumerable ENL in crops

• Pain/ tenderness in one or more nerves with/out loss of nerve function

• Accompanied by high fever• Generalized symptoms with painful

swelling of small joints with fever• Involvement of other vital organs like

kidneys, liver, bone • Recurrent ENL (more than 4 episodes in a

year)

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TREATMENT

• Omeprale 1x1• Antacid 2x1• Domperidon 2x1• MDT• Meloxim 1x1• B1B6B12

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DIFFERENTIAL DIAGNOSIS

• Eritema nodusum (EN)• Sarkoidosis• Erisipelas

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PROGNOSIS

• Leprosy patients that had been diagnosed late and does not get MDT have a high risk of nerve damage that can lead to disability.

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CONCLUSION

•Based on anamnesis and physical examination, diagnosiscan be confirmed. Chief complaint of Ny J is more toward to Leprae Reaction type ENL ( Erythema Nodusum Leprosum )