{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T16:02:11Z","timestamp":1777910531277,"version":"3.51.4"},"reference-count":10,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,10,18]],"date-time":"2013-10-18T00:00:00Z","timestamp":1382054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Type 2 lepra reaction is a Th2\u2010mediated type <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> hypersensitivity reaction in leprosy, with a characteristic cutaneous manifestation in the form of erythema nodosum leprosum (<jats:styled-content style=\"fixed-case\">ENL<\/jats:styled-content>). We describe unusual presentations of <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>ype 2 lepra reaction in five patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patient data and dermatological findings were analyzed in three men and two women diagnosed with <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ansen's disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Findings included multiple tender, polycyclic, necrotic lesions distributed over the face in one patient, and painful, fluid\u2010filled lesions on both arms and lower limbs in another. The third patient showed erythematous, tender nodules, bullae, and necrotic ulcers over the back and upper and lower limbs. The fourth showed erythematous tender nodules over the face, neck, back, and extremities, predominantly in sun\u2010exposed areas. The fifth revealed multiple erythematous, severely tender nodules and urticarial plaques mimicking those of <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>weet's syndrome. Diagnosis of borderline or lepromatous leprosy with atypical <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>ype 2 reaction were made in all cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Type 2 lepra reactions are antigen antibody\u2010mediated immune complex reactions that present with constitutional symptoms and <jats:styled-content style=\"fixed-case\">ENL<\/jats:styled-content> characterized by tender, erythematous, evanescent nodules mainly on the face, arms, and legs. Over 50% of lepromatous leprosy patients and 25% of borderline lepromatous leprosy patients experienced <jats:styled-content style=\"fixed-case\">type 2 lepra<\/jats:styled-content> reactions prior to the advent of multi\u2010drug therapy. Thalidomide is the drug of choice for severe <jats:styled-content style=\"fixed-case\">atypical lepra reactions<\/jats:styled-content> because of its anti\u2010tumor necrosis factor\u2010\u03b1 action. Awareness of these atypical variants and prompt diagnosis and treatment are essential to prevent mortality and morbidity in potentially treatable patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.12292","type":"journal-article","created":{"date-parts":[[2013,10,18]],"date-time":"2013-10-18T07:02:49Z","timestamp":1382079769000},"page":"323-326","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Rare atypical presentations in <scp>T<\/scp>ype 2 lepra reaction: a case series"],"prefix":"10.1111","volume":"53","author":[{"given":"Pragasam","family":"Vijendran","sequence":"first","affiliation":[{"name":"Department of Dermatology Command Hospital Pune India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajesh","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Dermatology Command Hospital Pune India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biju","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Department of Dermatology Command Hospital Pune India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debdeep","family":"Mitra","sequence":"additional","affiliation":[{"name":"Department of Dermatology Armed Forces Medical College Pune India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ambresh","family":"Badad","sequence":"additional","affiliation":[{"name":"Department of Dermatology Armed Forces Medical College Pune India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shekhar","family":"Neema","sequence":"additional","affiliation":[{"name":"Department of Dermatology Armed Forces Medical College Pune India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,10,18]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15952-7"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1996.tb03016.x"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1489\/1544-581X(2004)072<0149:LRHACI>2.0.CO;2"},{"key":"e_1_2_4_5_1","first-page":"165","volume-title":"Leprosy","author":"Pflatzgraff RE","year":"1985"},{"key":"e_1_2_4_6_1","first-page":"293","article-title":"Necrotic erythema nodosum leprosum: a presenting manifestation of lepromatous leprosy","volume":"61","author":"Verma KK","year":"1993","journal-title":"Int J Lepr Other Mycobact Dis"},{"key":"e_1_2_4_7_1","first-page":"145","article-title":"A fatal case of erythema necroticans","volume":"74","author":"Davis SV","year":"2002","journal-title":"Indian J Lepr"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2002.1428_2.x"},{"key":"e_1_2_4_9_1","first-page":"179","article-title":"Bullous type of reaction mimicking pemphigus in lepromatous leprosy","volume":"68","author":"Petro TS","year":"1996","journal-title":"Indian J Lepr"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4362.1987.tb02293.x"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)92686-7"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fijd.12292","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijd.12292","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T12:29:39Z","timestamp":1696336179000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijd.12292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,10,18]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1111\/ijd.12292"],"URL":"https:\/\/doi.org\/10.1111\/ijd.12292","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,10,18]]},"assertion":[{"value":"2013-10-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}