Question:medium
A 13 year old male presented with erythematous edematous plaques on face over his previously existing hypoanaesthetic patches. He also complained of pain since 10 days. He has been on MBMDT since the past 2 months. What is your diagnosis?
A 13 year old male presented with erythematous edematous plaques on face over his previously existing hypoanaesthetic patches. He also complained of pain since 10 days. He has been on MBMDT since the past 2 months. What is your diagnosis?
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When pre-existing leprosy skin patches become inflamed in a patient on MDT, think about the type of lepra reaction that involves pre-existing lesions.
Updated On: Jun 23, 2026
- Cellulitis of face
- Type 1 lepra reaction
- Erythema Nodosum Leprosum
- Erysipelas
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The Correct Option is B
Solution and Explanation
Key findings:
- 13-year-old male on MBMDT (leprosy patient)
- Erythematous, edematous plaques on face
- Occurring OVER pre-existing hypoanaesthetic patches
- Pain for 10 days
Diagnosis: Type 1 Lepra Reaction (Reversal Reaction)
Pathophysiology: Abrupt increase in cell-mediated immunity (CMI) against Mycobacterium leprae antigens leads to inflammation of previously established skin lesions.
Distinguishing from Type 2 (ENL):
- Type 1: involves pre-existing patches/plaques, nerve involvement common, borderline leprosy
- Type 2 (ENL): NEW subcutaneous nodules + systemic features (fever, malaise), lepromatous leprosy
Distinguishing from cellulitis/erysipelas:
- These are primary bacterial infections with no prior hypoanaesthetic skin patches
- No history of leprosy treatment
Management: Continue MDT + prednisolone (steroids) to prevent nerve damage
\[\boxed{\text{Type 1 lepra reaction}}\]
- 13-year-old male on MBMDT (leprosy patient)
- Erythematous, edematous plaques on face
- Occurring OVER pre-existing hypoanaesthetic patches
- Pain for 10 days
Diagnosis: Type 1 Lepra Reaction (Reversal Reaction)
Pathophysiology: Abrupt increase in cell-mediated immunity (CMI) against Mycobacterium leprae antigens leads to inflammation of previously established skin lesions.
Distinguishing from Type 2 (ENL):
- Type 1: involves pre-existing patches/plaques, nerve involvement common, borderline leprosy
- Type 2 (ENL): NEW subcutaneous nodules + systemic features (fever, malaise), lepromatous leprosy
Distinguishing from cellulitis/erysipelas:
- These are primary bacterial infections with no prior hypoanaesthetic skin patches
- No history of leprosy treatment
Management: Continue MDT + prednisolone (steroids) to prevent nerve damage
\[\boxed{\text{Type 1 lepra reaction}}\]
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