MEDizzy - A 53-year-old man from El Salvador presents with multiple

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Dermatology Test 1

A 53-year-old man from El Salvador presents with multiple violaceous painful subcutaneous nodules on his extensor surfaces and reports neuropathy and anesthesia of his upper and lower extremities. What type of reaction is this?

ExplanationThis patient most likely has erythema nodosum leprosum (ENL). He presents from an endemic area, with the typical lesions of ENL and associated neuropathy seen in this type of leprosy. This is considered borderline lepromatous leprosy and is considered a type 2 reaction. Type 1 reaction is either a downgrading or resolving reaction in tuberculoid or lepromatous leprosy and presents with nonspecific macular or papular skin eruption with satellite lesions and constitutional symptoms. Jarisch-Herxheimer reaction is found after treatment of secondary syphilis resulting from release of endotoxin from spirochetes. Lucio reaction occurs specifically in individuals with leprosy from Mexico or the Caribbean and appears as large ulcerations of the lower extremities.