Infectious diseases: erythema nodosum leprosum: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: erythema nodosum leprosum

Sample item

A man with lepromatous leprosy has been on multidrug therapy for 6 months. He develops fever, tender red subcutaneous nodules, joint pain and new neuritis. What is the immunological basis of this reaction?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Immune-complex deposition (type III hypersensitivity)

Erythema nodosum leprosum is the type 2 lepra reaction seen in lepromatous disease, caused by antigen-antibody complexes and neutrophil infiltration. Treatment is with corticosteroids or thalidomide while continuing multidrug therapy.

Option by option

  • A. Delayed-type (type IV) upgrading reaction

    A cell-mediated upgrading reaction describes the type 1 reaction of borderline disease.

  • B. Antibody-mediated cytotoxicity (type II)

    Type II cytotoxic reactions are not the basis of this reaction.

  • C. Type I IgE-mediated reaction

    IgE-mediated reactions cause urticaria and anaphylaxis.

  • D. Immune-complex deposition (type III hypersensitivity) (correct)

    Correct. Type 2 reaction results from immune complex deposition.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Immune-complex deposition (type III hypersensitivity). Erythema nodosum leprosum is the type 2 lepra reaction seen in lepromatous disease, caused by antigen-antibody complexes and neutrophil infiltration.

Why is "Delayed-type (type IV) upgrading reaction" not the answer?

A cell-mediated upgrading reaction describes the type 1 reaction of borderline disease.

Why is "Antibody-mediated cytotoxicity (type II)" not the answer?

Type II cytotoxic reactions are not the basis of this reaction.

Why is "Type I IgE-mediated reaction" not the answer?

IgE-mediated reactions cause urticaria and anaphylaxis.

What concept does this question test?

It tests Infectious diseases: erythema nodosum leprosum in General Medicine. Treatment is with corticosteroids or thalidomide while continuing multidrug therapy.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: erythema nodosum leprosum?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.