02890nas a2200241   4500000000100000008004100001260003400042653001200076653001100088653003000099653001800129100001200147700001700159700001200176700001400188700001700202700001300219700001200232700001300244245010800257520225800365022002502623       2024                            d  bOxford University Press (OUP)10aLeprosy10aVision10aErythema Nodosum Leprosum10aScleromalacia1 aMalhi K1 aHanumanthu V1 aSingh S1 aBishnoi A1 aChatterjee D1 aBansal R1 aDogra S1 aNarang T00aScleromalacia perforans: a rare and sight-threatening complication of chronic erythema nodosum leprosum3 a<p><strong>Extract</strong></p>

<p><strong>Dear Editor</strong>,</p>

<p>Leprosy, a chronic infectious disorder affecting nerves, skin and eyes, requires early detection and prompt treatment to prevent associated morbidity. Neurological and ophthalmological complications significantly impact patients.<sup>1</sup>&nbsp;Additionally, immunologically mediated reactions in leprosy present various clinical features and adverse outcomes. Here, we detail a case of chronic erythema nodosum leprosum (ENL) in lepromatous leprosy (LL), complicated by scleromalacia perforans and exudative retinal detachment.</p>

<p>A 35-y-old female patient with no known comorbidities presented to the dermatology department with fever and recurrent episodes of multiple ulcerative lesions over her abdomen, trunk and extremities for 1 mo. She also complained of pain in the small joints of her hands, not associated with local swelling. Her laboratory investigations revealed anaemia, leukocytosis with neutrophilia, and normal liver and renal function tests. Her viral markers such as HIV, Hepatitis B surface antigen (HbsAg), anti-HCV and venereal disease research laboratory (VDRL), and treponema pallidum hemagglutination (TPHA), were negative. Immunological tests such as rheumatoid factor, anti-nuclear antibody test (ANA) and anti- neutrophil cytoplasmic antibody (ANCA), were also negative. Upon cutaneous examination, multiple nodules, pustules and ulcero-necrotic skin lesions were present over the trunk and the extensor aspects of the upper and lower extremities (Figure&nbsp;1A). Upon examination, the median and radial cutaneous nerve were thickened over the right side, and there was a loss of sensation to fine and crude touch over the palmar and dorsal aspect of the right hand. On slit skin smear examination, her bacillary index and morphological index were 6+ and 10%, respectively. Histopathology confirmed the diagnosis of LL with ENL and showed acid-fast bacilli arranged in clusters/globi (Figure&nbsp;1B,C). She had not been treated for leprosy before and, thus, was classified as a new case of multibacillary (MB) leprosy. She also denied having received any treatment for ENL episodes and did not appear Cushingoid at presentation.</p>
  a0035-9203, 1878-3503