We describe a patient of borderline Hansen with multiple symmetric nerve abscesses, as a manifestation of Type 1 downgrading reaction.
In our case repeated biopsy from the presenting lesion demonstrated a log increase in the number of bacilli, thus a manifestation of Type1 downgrading reaction. Multiple nerve abscesses with multiple nerve involvement is uncommon in the upper pole of leprosy.
Clinically the distinction between upgrading and downgrading reactions is difficult to make and may require repeated examinations.
The clinical course of leprosy is often interrupted by reactions which are acute inflammatory episodes that can be classified as Type I ('Upgrading reaction' or 'Downgrading reaction
') and Type II reaction.
leprae), downgrading reaction (associated with a rapid decline in CMI) and static reaction (without any change in the immunity).
None developed downgrading reaction while on treatment.
We believe that a rise in MI during T1R, points to a downgrading reaction. We restarted her on MB MDT and the patient showed clinical and bacteriological improvement.
Similarly, the rarity of downgrading reactions in the present study may be due to the heightened immunity in the study population as well as due to incorrect classification.