Archives of Medicine and Health Sciences

TEACHING IMAGES
Year
: 2021  |  Volume : 9  |  Issue : 1  |  Page : 171--172

“Deck chair sign” presenting in type 1 lepra reaction


Amina Asfiya, Manjunath Mala Shenoy, Vishal B Amin, Malcolm Pinto, Spandana Prakash Hegde, Ashmiya Abdul Razak 
 Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Mangalore, Karnataka, India

Correspondence Address:
Dr. Amina Asfiya
Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Deralakatte, Mangalore - 575 018, Karnataka
India

Abstract

Deck chair sign (DCS) was first described in papuloerythroderma of Ofuji as the characteristic pattern of sparing of the skin folds which resembles the narrow strips of a deck chair. The sparing of skin folds includes areas such as the inguinal, axillary, sub-mammary, and flexural regions. Although first described in papuloerythroderma of Ofuji, it is also seen in other inflammatory dermatoses. We report a case of borderline leprosy in type 1 reaction who presented with the DCS involving the abdominal folds which to the best of our knowledge is the first of its kind.



How to cite this article:
Asfiya A, Shenoy MM, Amin VB, Pinto M, Hegde SP, Razak AA. “Deck chair sign” presenting in type 1 lepra reaction.Arch Med Health Sci 2021;9:171-172


How to cite this URL:
Asfiya A, Shenoy MM, Amin VB, Pinto M, Hegde SP, Razak AA. “Deck chair sign” presenting in type 1 lepra reaction. Arch Med Health Sci [serial online] 2021 [cited 2021 Sep 18 ];9:171-172
Available from: https://www.amhsjournal.org/text.asp?2021/9/1/171/319368


Full Text



 Case Report



A 50-year old female, housewife by occupation, presented with multiple patches over the face, arm, abdomen, and legs with the loss of sensation over the patches. Cutaneous examination revealed bilateral earlobe infiltration. Multiple ill-defined erythematous plaques were noticed over the abdomen, upper arm, back, and right lower limb. The bilateral ulnar nerve, greater auricular nerve, and common peroneal nerve were thickened symmetrically. Slit-skin smear was done which showed bacteriological index of 2+. With borderline leprosy as the diagnosis, the patient was started on WHO-recommended multibacillary multidrug therapy comprising rifampicin, dapsone, and clofazimine. After 2 months of treatment, the patient noticed swelling and redness over the face and patch on the trunk. On examination, the plaque on the lower abdomen showed erythema with ill-defined border and characteristic sparing of the abdominal skin folds depicting the deck chair sign (DCS) [Figure 1]. Facial erythema and edema were also noted [Figure 2]. The diagnosis of upgrading type of lepra reaction with Deckchair sign was made.{Figure 1}{Figure 2}

 Discussion



Though DCS is characteristic of Papuloerythroderma of Ofuji it has also been reported in various other inflammatory conditions such as angioimmunoblastic T-cell lymphoma, adult T-cell leukemia/lymphoma, mycosis fungoides, Waldenstrom's macroglobulinemia, drug-induced erythroderma, diffuse leprosy,[1] parthenium dermatitis,[2] erythroderma owing to various causes, acanthosis nigricans, erysipelas, discoid lupus erythematosus, and contact dermatitis.[3]

The pathogenesis underlying DCS may involve several mechanisms depending on the clinical condition. In cases of leprosy, sparing of body folds is thought to be due to the higher body temperature. Mycobacterium leprae relatively spares such areas and leads to the formation of so-called “immune zones,” which includes the scalp, palms, soles, genitalia, axillae, transverse band of skin over the lumbosacral region, eyelids, perineum, and center of the back.[1],[4] The occurrence of DCS in our case may be attributable to abdominal crease forming an immune zone. We did not observe this sign during her previous visits; we believe that the onset of type 1 reaction and the clofazimine induced pigmentation has enhanced the leprosy lesion and intensified the DCS. Although DCS has been described in the past with diffuse leprosy[1] and lepromatous leprosy,[3] its occurrence in a case of type 1 lepra reaction is described for the first time.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Shenoy MM, Bendigeri MA, Kamath PR, Vishal B. Diffuse leprosy with “deck-chair” sign. Indian Dermatol Online J 2015;6:204-6.
2Pai S, Shetty S, Rao R. Parthenium dermatitis with deck-chair sign. JAMA Dermatol 2015;151:906-7.
3Prashar A, Narang T, Saikia UN, Dogra S. Deck chair sign in lepromatous leprosy. Lepr Rev 2013;84:252-4.
4Rajashekar TS, Singh G, Naik LC. Immune zones in leprosy. Indian J Dermatol 2009;54:206-10.