Clinical Spectrum, Histopathological Profiles, and Determinants of Physical Disability Among Patients with Leprosy Reactions: A Five-Year Retrospective Study at a Tertiary Referral Hospital in Surakarta, Indonesia

Abstract

Background: Leprosy reactions are acute immune-mediated complications that precipitate severe neuritis and permanent physical disability. Data on reaction phenotypes, comorbidities, and disability determinants in Indonesian tertiary referral centers remain scarce.

Objective: To determine clinical phenotypes, histopathological profiles, comorbidities, and determinants of permanent physical disability among patients with leprosy reactions at Dr. Moewardi Regional General Hospital, Surakarta, Indonesia.

Methods: A five-year retrospective observational study evaluated 45 consecutive patients with leprosy reactions between January 2020 and December 2024. Reaction subtypes (type 1, type 2/ENL, and Lucio phenomenon), comorbidities, and histopathology were analyzed. Bivariate and multivariable binary logistic regression assessed factors associated with permanent physical disability.

Results: Of 45 patients, 77.8% were male. ENL was the most frequent reaction (48.9%), followed by Lucio phenomenon (28.9%) and type 1 reaction (22.2%). Comorbidities occurred in 62.2% of patients, most commonly diabetes mellitus and anemia (11.1% each). Of 24 biopsied patients, 37.5% had Lucio phenomenon. Systemic corticosteroids were used in most patients; 31.8% of ENL patients received methotrexate. Permanent physical disability occurred in 20.0% of patients. In multivariable analysis, Lucio phenomenon (adjusted odds ratio [aOR] = 4.12, 95% CI: 1.18–14.38, p = 0.0264) and anemia (aOR = 3.48, 95% CI: 1.05–11.52, p = 0.0415) were independently associated with disability (area under the curve = 0.824).

Conclusion: Necrotizing Lucio phenomenon and comorbid conditions were frequent in this referral cohort. Lucio phenomenon and concurrent anemia were independently associated with permanent physical disability, supporting early systemic screening and prompt treatment; these findings rest on nine disability events and need confirmation in larger studies.