02258nas a2200229   4500000000100000008004100001260001300042653002800055653001100083653001200094653002300106653000900129653001600138653001400154653001700168100001700185245007800202300001100280490000700291520171600298022001402014       2003                            d  c2003 Dec10aDiagnosis, Differential10aHumans10aleprosy10aLymphatic Diseases10aMale10aMiddle Aged10aPrognosis10aRisk Factors1 aRodríguez G00a[Generalized adenopathy as a manifestation of type 2 reactional leprosy].  a373-870 v233 a<p>Generalized adenopathy as a manifestation of type 2 reactional leprosy Leprosy patient's reactions are severe clinical manifestations of acute inflammation of chronic lesions, capable of producing irreversible and invalidating damage. We studied a 46 year-old man with a type 2 leprosy reaction, who presented fever, cutaneous nodules, nasal obstruction and generalized adenopathy. The hemogram showed leucocytosis with neutrophilia. None of the initial diagnoses included leprosy. A lymph node biopsy revealed extensive necrotic areas infiltrated with polymorphonuclear lymphocytes, and foamy macrophages. Eosinophylic necrosis and thrombosis of venules with lymphoid nodule depletion was also in evidence. Ziehl Neelsen stain was not done, but the Gomori stain clearly showed Hansen's bacilli. These were were not detected by the pathologist and therefore a final diagnosis was not provided. Twenty months later, the patient presented similar symptoms, but with more generalized lymphadenopathy and presence of cutaneous nodules. Nodule biopsy showed lepromatous leprosy with erythema nodusum leprosum or type 2 reaction. Polychemotherapy treatment and anti-reaction treatment with thalidomide cured the patient. No sequelae were noted in 3 years following the treatment. A literature review of the type 2 reaction in leprosy is provided, including discussion of risk factors, histopathology, differential diagnosis for leprosy adenopathy, pathogenesis, prognosis, and treatment. Type 2 leprosy must be treated immediately upon diagnosis as it can cause serious and permanent tissue damage. As had occurred in the above patient, the disease can proceed with generalized and symptomatic lymphadenopathy.</p>  a0120-4157