Downgrading Reaction

A subacute deterioration in the clinical and immune status in patients with leprosy, accompanied by increased load of organisms, due either to poor drug compliance, or emergence of a drug-resistant strain of Mycobacterium leprae
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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.
Clinically the distinction between upgrading and downgrading reactions is difficult to make and may require repeated examinations.
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.
This presentation of downgrading reaction as a late T1R highlights the fact that a total lack of immunity against M.
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.