Preliminary CommunicationsERYTHEMA NODOSUM LEPROSUM: A CLINICAL MANIFESTATION OF THE ARTHUS PHENOMENON
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Erythema Nodosum Leprosum: Update and challenges on the treatment of a neglected condition
2018, Acta TropicaCitation Excerpt :ENL is a systemic inflammatory reaction characterized as acute episodes, which may be recurrent, in the chronic course of the disease (Campos and de Souza, 1954). At an immunological point of view, ENL is often described as a neutrophilic immune-complex-mediated condition because it has some clinical features in common with the Arthus reaction and its multisystem involvement resembling autoimmune diseases as systemic lupus erythematosus (Polycarpou et al., 2017; Wemambu et al., 1969). Many studies provide evidence of an association between immune complexes and ENL but they do not necessarily support that they are the trigger leading to ENL.
Treatment of severe refractory erythema nodosum leprosum with tumor necrosis factor inhibitor Etanercept
2016, International Journal of MycobacteriologyCitation Excerpt :The underlying immunopathological mechanism for ENL remains unclear. ENL has traditionally been considered an immune complex–mediated phenomenon with an accompanying vasculitis [2–4]. However, high levels of TNF-α and IL6 are consistently found in patients with more severe forms of the disease, suggesting that a cell-mediated immune response also plays a role [5].
Advances in leprosy immunology and the field application: A gap to bridge
2016, Clinics in DermatologyCitation Excerpt :Reactions are thought to be immune exacerbations, as can be postulated from the changes in the characteristic proportion of lymphocytes to histiocytes and interpreted due to the lymphocytic reactivities to M leprae and its antigens.11 Principally, two types of reactions are seen: (1) type 1, or reversal reaction (RR), localized to dermal patch and neighboring nerves, with acute increases in both matured and blast lymphocytes, most likely being M leprae–specific, indicating an increase specific cell-mediated immunity accompanied by excessive release of type 1 helper T cell (Th1) cytokines in the tissue; (2) type 2 reaction, or erythema nodosum leprosum (ENL), the histopathology of which appears to be complex, involving immune complex deposition in the vessel walls12 and later in the tissues13 besides the fluctuation of T-cell immunity that also plays important role. The main features of reactions are summarized in Figures 1 and 2.
Immunology of leprosy and diagnostic challenges
2015, Clinics in DermatologyRegulatory T cells in erythema nodosum leprosum maintain anti-inflammatory function
2022, PLoS Neglected Tropical DiseasesImmunology of leprosy
2022, International Reviews of Immunology