D. Borderline tuberculoids.
The patient is suffering from Type II Lepra reaction(Erythema Nodosum)
Type II lepra reactions (ENL) is seen in Lepromatous Leprosy. Erythema nodosum leprosum is a type III hypersensitivity.
|Signs||Type I||Type II|
|Type of reaction||Delayed Hypersensitivity,associated with an increase in cell-mediated immunity.It is a type IV delayed hypersensitivity.||Antigen antibody reaction due to the deposition of extravascular immune complexes,type III hypersensitivity|
|Inflammation of the skin||Skin lesions suddenly becomes reddish, swollen, warm, painful,tender but the rest of the skin is normal||Red, painful, tender, cutaneous nodules (deep) appear that are not associated with leprosy patches. ENL may appear commonly on face, arms, legs.|
|Cytokines involved||Increased activity of T helper (Th)-1 lymphocytes expressing IL-2 and IFN-γ.IL-12 is consistently expressed and IL-4 is absent. The IFN-γ and TNF-α producing CD4 cells and T cytotoxic cells are selectively increased ..||Tumor necrosis factor-alpha play a central role in the pathobiology of type II lepra reaction/ ENL. A predominant Th2 cytokine profile has been observed with increased expression of IL-6, IL-8, and IL-10 as well as sustained production of Th2 cytokines, IL-4, and IL-5.|
|Nerve involvement||Nerves close to skin may be enlarged, tender and painful (neuritis) with loss of nerve function (loss of sensation and muscle weakness) and may appearsuddenly or rapidly||Nerves may be affected but not as common or severe/acute as in Type I|
|General conditionof the patient||Good, with little or no fever||Poor, with fever and general malaise|
|Timing of presentation and type of patient||Usually early on in the course ofMDT; occurs in people with bothPB and MB,more common in patients between the two poles of the leprosy spectrum with immunologically unstable borderline forms,with a significantly higher incidence in BB and BL patients as compared with BT patients.||Usually later in the treatment; occurs in people with MB leprosy,seen in borderline lepromatous (BL) and lepromatous leprosy (LL)|
|Eye involvement||Weakness of eyelid closure may occur (nerve involved)||Internal eye disease (iritis) occurs|
|Other Organs||Not affected||May be affected like periosteal pain (especially tibiae), muscle pain (myositis), pain and swelling of the tendons and joints, rhinitis, epistaxis, painful dactylitis, swollen tender lymph nodes especially femoral, acute epididymo-orchitis, hepato-splenomegaly with hepatitis and endocarditis with/without arhythmia,Glomerulonephritis.|
|Treatment||If the Type 1 reaction is mild and there is no evidence of neuritis (pain, loss of sensation or function), the reaction should be treated with analgesics, such as acetylsalicylic acid or paracetamol. However, if there is nerve involvement, treat type 1 reactions with analgesics and corticosteroids, such as oral prednisolone.||Therapy for type 2 reactions may include analgesics, such as acetylsalicylic acid or paracetamol, and corticosteroids, such as oral prednisolone.In patients with severe type 2 reactions, who do not respond to corticosteroids or in whom corticosteroids are contraindicated, clofazimine at high doses or thalidomide may be used|