[Leprosy with an unusual course]. / Une lèpre d'évolution atypique.

In developed countries, Hansen disease, or leprosy, is a rare and little-known disease. Over the last few years, its prevalence in New Caledonia has remained stable (0.35 per 10,000 inhabitants). We report the case of an 11-year-old child who presented lepromatous leprosy complicated by a type 2 reaction. Despite appropriate treatment, the course was unusual with fever lasting a few weeks associated with asthenia, weight loss, and biological perturbations such as inflammatory syndrome, anemia, and hyperferritinemia. After a brief review of Hansen disease and its complications, we discuss the different hypotheses that can explain the clinical and biological progression of our patient (hemolytic anemia secondary to dapsone, type 2 reaction, and aspects of hemophagocytic syndrome) and describe therapeutic management, which led to a good outcome.

[Profile of leprosy in New Caledonia. Evolution from 1983-1998]. / Bilan de la lèpre en Nouvelle-Calédonie. Evolution de 1983 à 1998.

The authors report the results of a retrospective study on the evolution of leprosy in New-Caledonia, French island in Oceania, between 1983, time of the onset of polychemotherapy (PCT), and 1998. Since 1996, the prevalence is and remains less than 1/10,000. The annual rate detection fall from 15.6 in 1983 to 2.48/100,000 in 1998. Less than 10 new cases are detected annually since 1994. During this period, the number of new patients less than 15-years old decreased and the percentage of multibacillary patients increased, assessing a priori the improvement of the endemicity. One case of relapse was detected in a MB patients treated for 2 years among the 231 new patients.

[Leprosy in New Caledonia from 1983 to 1992. Histopathological and epidemiological data]. / La lèpre en Nouvelle-Calédonie de 1983 à 1992. Données histopathologiques et épidémiologiques.

New Caledonia is a South Pacific Island inhabited by more than 170,000 people: most of them are melanesians or europeans. Multidrug therapy for Hansen disease has been employed since 1983; so we made an epidemiologic and histopathologic study of the new cases diagnosed for 10 years, from 1983 to 1992. Local (clinical, histological, microbiological and immunological) means of diagnosis are described. In New Caledonia, the endemic level is lower than in the small neighbouring Pacific islands but there is still a native reservoir of Mycobacterium leprae with 40% multibacillary types. Nearly half of the new cases are less than 25 years old. They are often male melanesians. The diagnosis of indeterminate forms is debated when there is no acid-fast bacillus. Border-line forms are rare. Tuberculoid leprosy poses many differential diagnosis problems. Despite available multidrug therapy, one cannot yet consider that the incidence is decreasing significantly.