Necrotizing Vasculitis Due to a Severe Type II Leprosy Reaction

Introduction: Despite the wide spectrum of the clinical manifestations of leprosy, necrotizing cutaneous vasculitis has rarely been reported as a manifestation of this disease. We report a case of cutaneous vasculitis due to a type II leprosy reaction, secondary to lepromatous leprosy. Case report: A 38-years-old Gambian man was admitted for necrotic and infiltrated purpura of acral distribution (limbs, ears and nose), which was associated with multiple subcutaneous inflammatory nodules, epistaxis, polyarthralgia, fever and a poor general health status. Mycobacterium Leprae was isolated from the nasal mucosa (bacillary index 3 +) and the biopsy of the purpuric lesions revealed a leukocytoclastic vasculitis. A multidrug therapy concurrently with oral corticosteroids was started with good clinical results after 4 weeks. Discussion: Cutaneous necrotizing vasculitis has been described as a rare manifestation of eryhtema nodosum leprosum in medical literature. We think, in endemic areas, erythema nodosum leprosum can be added to the list of the possible etiologies of cutaneous vasculitis.