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제목 |
나반응 |
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저자 |
박석돈 |
소속 |
원광대학교 의과대학 피부과학교실 |
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년도 |
1997 |
권 |
30 |
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호 |
1 |
번호 |
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시작페이지 |
9 |
끝페이지 |
30 |
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첨부 |
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요약 |
Reactions that occur in leprosy( lepra reaction ) are acute episodes of inflammation
that are immunologically mediated and are liable to damage tissues infected with
Mycobacterium leprae.
There are two types, type I (reversal reaction) and type Ⅱ (erythema nodosum
leprosum) reactions. Type I reaction is associated with an abrupt alterations in
cell-mediated immune (CMI) reactions to mycobacterial antigen, one associated with
increase in CMI (upgrading) and the other with decrease in CMI( downgrading reaction).
Upgrading reaction consists of inflammation of existing lesion. Downgrading reaction
leads to appearance of new skin lesions Neuritis may be severe and may lead to loss of
nerve function. Type Ⅱ reaction occurs in patients with multibacillary disease and cause
acute inflammation in any organ or tissue where M. leprae are found. It is caused by
extravascular deposition of immune complex(mycobacterial antigen, immunoglobulin and
complement) and dysfunction of CMI. In the skin, type Ⅱ reaction causes erythema
nodosum leprosum(ENL). Uveitis, arthritis, neuritis, lymphadenitis, nephritis, and orchitis
may accompany ENL, or occur separately. Lucio's phinomenon is an unusual type Ⅱ
reaction, common in Mexico and characterized clinically by deep painful ulcers in a
patient with diffuse nonnodular lepromatous leprosy. I review the clinical and
histopathological findings, and the up-to-date management of lepra reaction. |
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