Elsevier

The Lancet

Volume 294, Issue 7627, 1 November 1969, Pages 933-935
The Lancet

Preliminary Communications
ERYTHEMA NODOSUM LEPROSUM: A CLINICAL MANIFESTATION OF THE ARTHUS PHENOMENON

https://doi.org/10.1016/S0140-6736(69)90592-3Get rights and content

Abstract

Granular deposits of immunoglobulin and complement were found by fluorescence microscopy in the dermis of lesions from patients with erythema nodosum leprosum. In some cases the deposits apparently also contained soluble mycobacterial antigen. The distribution of these deposits corresponded with the areas of polymorph infiltration. It is suggested that erythema nodosum leprosum is a manifestation of the Arthus phenomenon. In a few of the patients studied the level of the third component of complement in the serum was raised.

References (12)

  • M.F.R. Waters et al.

    Int. J. Lepr.

    (1967)
  • M.F.R. Waters et al.

    Int. J. Lepr.

    (1963)
  • C.G. Cochrane et al.

    Immunopathology

  • D.S. Ridley

    Lepr. Rev.

    (1969)
  • M.R. Mardiney et al.

    J. Immun.

    (1965)
There are more references available in the full text version of this article.

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