NL necroticans versus chicken pox versus small pox?

Leprosy Mailing List – March 2nd, 2011

Ref: ENL necroticans versus chicken pox versus small pox?
From: Salafia A., Mumbai, India
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Dear Salvatore,

I thank your for the prompt action following my request. I must thank Jaison Barreto for the time taking in answering and Ben Naafs. The latter, who I cordially greet, gives some light and I too was thinking of methotrexate.

For the records: in severe neuritis I advice IV of 8-16 mg of betha or dexametasone to be given slowly; this therapy usually brings remission for about a week.

In this your girl aged 12 but, her body weight is about 20 kg, I gave IV infusion of 4 mg of bethametasone; her pain stopped; but within two days she was restless and started crying bitterly. She is an advasi girl from a village, and her pain was severe. Within a day she developed small blisters which kept on increasing in number but not in size. On a first impression I thought of ENL necroticans (very common in India and I had written a paper on it a few years ago). But after a day there was not necrosis no pus formation and the blisters kept on increasing in number. At this point I changed my diagnosis and -while not ruling out the ENL- I started thinking in terms of chicken pox or something similar. The patient was shifted to Kasturba hospital which is a government institution specializing in infective disease; a temporary diagnosis of chicken pox was made and IV injections (very costly) of vaccine against varicella was started.

I am waiting for the latest news and diagnosis. Yet something does not seem right, the blisters, the extensive spread, practically the whole body is covered with small blisters which were not purulent till yesterday; could it be a case of small pox? But then the governmet of India has solemnly affirmed that small pox is totally eradicated from India. Yet, if my memory serves me right, a couple of months ago there was a report of small pox in some remote village.

Thanks for the patience.

Antonio