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February 1977

Erythema Nodosum Leprosum-Reply

Author Affiliations

Los Angeles

Arch Dermatol. 1977;113(2):234-235. doi:10.1001/archderm.1977.01640020106023

In Reply.—  Dr Londono and co-workers report the presence of complement but the absence of immunoglobulin in the vessel walls of erythema nodosum leprosum (ENL) lesions, findings similar to those reported by Fields and Abel1 in two patients with ENL.On the basis of these findings, Londono and his co-workers hypothesize that complement plays an important role in ENL but immunoglobulin does not. We agree that the pathogenesis of ENL is uncertain and welcome the hypothesis of Londono et al because it will surely stimulate further investigation. However, there are difficulties with this hypothesis.It is hard to know whether the failure to demonstrate immunoglobulin by conventional direct immunofluorescence means that immunoglobulin is not present. Wemambu et al2 and Waters and associates3 demonstrated immunoglobulin by a "sandwich" technique, ie, the application of unconjugated rabbit antihuman immunoglobulin followed by fluoroscein-conjugated goat antirabbit immunoglobulin, presumably more sensitive than the usual direct

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