Towards understanding the pathology of erythema nodosum leprosum
- 1 April 2008
- journal article
- review article
- Published by Oxford University Press (OUP) in Transactions of the Royal Society of Tropical Medicine and Hygiene
- Vol. 102 (4), 329-337
- https://doi.org/10.1016/j.trstmh.2008.01.004
Abstract
Erythema nodosum leprosum (ENL) is an immune-mediated complication of leprosy presenting with inflammatory skin nodules and involvement of multiple organ systems, often running a protracted course. Immune complex production and deposition as well as complement activation have long been regarded as the principal aetiology of ENL. However, new data show that cell-mediated immunity is also important. We have performed a critical analysis of studies on the pathology of ENL. Our main findings are as follows. ENL is characterised by an inflammatory infiltrate of neutrophils with vasculitis and/or panniculitis. There is deposition of immune complexes and complement together with Mycobacterium leprae antigens in the skin. Changes in serum levels of Igs indicate a transient, localised immune response. The major T-cell subtype in ENL is the CD4 cell, in contrast to lepromatous leprosy where CD8 cells predominate. The cytokines TNFα and IL-6 are consistently found whilst IL-4 is low or absent in ENL lesions, indicating a TH1 type response. Keratinocyte 1a and intercellular adhesion molecule-1 (ICAM-1) have been shown to be present in the epidermis in ENL, which is evidence of a cell-mediated immune response. Co-stimulatory molecules such as B7-1 have also been studied but further work is needed to draw strong conclusions. We also highlight potential areas for future research.Keywords
This publication has 32 references indexed in Scilit:
- Expression of metalloproteinases (MMP‐2, MMP‐9, and TACE) and TNF‐α in the nerves of leprosy patientsJournal of the Peripheral Nervous System, 2007
- Role for Matrix Metalloproteinase 9 in Granuloma Formation during PulmonaryMycobacterium tuberculosisInfectionInfection and Immunity, 2006
- Immunopathologic role of B lymphocytes in rheumatoid arthritis: Rationale of B cell-directed therapyAutoimmunity Reviews, 2006
- Association of C4B deficiency (C4B*Q0) with erythema nodosum in leprosyClinical and Experimental Immunology, 1993
- REACTION IN LEPROSY: ACUTE PHASE REACTANT RESPONSE DURING AND AFTER REMISSIONInternational Journal of Dermatology, 1992
- Immune complexes and antibody levels in blisters over human leprosy skin lesions with or without erythema nodosum leprosumClinical Immunology and Immunopathology, 1992
- Immunoprofile of Reactions in LeprosyInternational Journal of Dermatology, 1986
- IgM and IgG Antibodies to Phenolic Glycolipid I from Mycobacterium leprae in Leprosy: Insight into Patient Monitoring, Erythema Nodosum Leprosum, and Bacillary PersistenceJournal of Investigative Dermatology, 1986
- Tissue and blood T-lymphocyte subpopulations in erythema nodosum leprosumArchives of Dermatology, 1985
- ERYTHEMA NODOSUM LEPROSUM IN THE ABSENCE OF CHEMOTHERAPY: A ROLE FOR CELL-MEDIATED IMMUNITYThe Lancet, 1972