Ref.: (LML) ENL (T2R) and RR (T1R) in the same patient
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
Recently I got the question how do you explain: "ENL (T2R) and RR (T1R) in the same patient".
After some thinking I came to the following:
- In an Upgrading Reversal Reaction when the CMI goes up, the antigens go down . Environmental bacteria or increased antigens from internal sources may stimulate CMI and cause a reaction. (a.o. BCG).
- When you have a downgrading reaction, the antigens don't diminish, the patient is untreated or treatment resistant ergo antigens go up ( Bacilli divide) and immune complexes form and ENL occurs. (Here ENL after RR)
- ENL happens when there is a certain balance in the tissues between antigens and antibodies and immune complexes form.
- During ENL there is tissue destruction – antigens will be exposed and a reversal reaction may occur. Interesting BCG works against ENL. (Here RR after ENL)
Realize that there are topical differences in one patient so, at the same time you can have ENL and RR at the same time.
I would like to ask other LML readers whether they have a better explanation.
With regards
Ben
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LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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