Four patients with severe erythema nodosum leprosum were treated by plasma exchange and/or fresh frozen plasma infusions after failure of classical therapy.
After the procedures, the patients improved rapidly; with a follow-up between 4 and 7 years after the last plasma exchange, no clinical relapse was noted. The replacement fluids were variable; the most beneficial procedure seemed to be plasma exchange replaced with fresh frozen plasma.
Elimination of circulating immune complexes, replacement of a lacking plasma factor are possible mechanisms of action. Plasma exchange may also work like a regulator of immune mechanisms, since it has been shown that there is a depression of suppressor cells in erythema nodosum leprosum.
WemambuS.N.C., TurkJ.L., WatersM.F.R., ReesR.J.W.Erythema nodosum leprosum: a clinical manifestation of the Arthus phenomenon.Lancet1969; ii, 933.
2.
MshanaR.N.Hypothesis: Erythema nodosum leprosum is precipitated by an imbalance of T lymphocytes.Lepr Rev1982; 53: 1.
3.
WallachD., CottenotF., BachM.A.Imbalances in T cell subpopulations in lepromatous leprosy.Int J Lepr1982; 50: 282.
4.
GodalT.Immunological aspects of leprosy. Present status.Prog Allergy1978; 25: 211.
5.
Mac AdamKPWJ, AndersR.F., SmithR.R., RusselD.A., PriceM.A.Association of amyloidosis with erythema nodosum leprosum reactions and recurrent neutrophil leucocytosis in leprosy.Lancet1975; ii: 572.
6.
WallachD., BusselA., SansonnettiP., PennecJ., CottenotF.Echanges plasmatiques dans les lèpres lépromateuses.Acta Leprol1979; 76-77: 285.
RidleyD.S., JoplingW.H.Classification of leprosy according to immunity. A five group system.Int J Lepr1966; 34: 255.
9.
RidleyD.S., HiltonG.R.F.A logarithmic index of bacilli in biopsies.Int J Lepr1967; 35: 184.
10.
ContrerasF., GuillenJ.Torella E, Alcaraz M. Tratamiento de la reaccion leprotica (lepro-reaccion leprotica) con plasma.Int J Lepr1952; 20: 317.
11.
ContrerasF., GuillenJ., PonzianiJ., TerencioJ.Hemoterapia en las leproreacciones.Int J Lepr1953; 21: 441.
12.
de las AguasJTTratamiento de las leproreacciones.Fontilles1962; 5: 513.
13.
de las AguasJTLeproreacciones. Su tratamiento.Fontilles1966; 6: 431.
14.
Almeida GonçalvesJ.C., CustodioJ.Treatment of Mitsuda-negative leprosy patients with transfusions of whole blood from Mitsuda-positive donors.Lepr Rev1975; 46: 15.
15.
PiepkornM., GarelliS.Auricular chondritis as a rheumatologic manifestation of Lucio's phenomenon: clinical improvement after plasmapheresis.Ann Intern Med1983; 98: 49.
Verrier-JonesJ., CummingsR.H., BaconP.A., EversJ., FraserI.D., BothamleyJ., TribeC.R., DavisP., HughesG.R.V.Evidence for a therapeutic effect of plasmapheresis in patients with systemic lupus erythematosus.Quat J Med1979; 58: 555.
18.
FaberW.R., LeikerD.L., CormaneR.H.Immunofluorescence studies in reactional leprosy with relevance to treatment.Arch Dermatol Res1978; 261: 232.
19.
WallachD., FlageulB., BachM.A., CottenotF.The cellular content of dermal leprous granulomas: an immuno-histological approach.Int J Lepr1984; 52: 318.
20.
CloughJ., CalabreseL.H.Theoretical aspects of immune complexes removal by plasmapheresis.Plasma Therapy1981; 2: 73.
21.
LockwoodC.M., WorlledgeS., NicholasA., CottonC., PetersO.K.Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange.New Engl J Med1979; 300: 525.
22.
AbdouN.I., LindsleyH.B., PollockA., StechschulteD.J.Plasmapheresis in active systemic lupus erythematosus: effects on clinical, serum and cellular abnormalities. Case report.Clin Immunol Immunopath1981; 19: 46.
