Download - Leprae Reaction Type Enl
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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 )