Case Report: Borderline Lepromatous Leprosy Therapy Complicated by Type 1 Leprosy Reaction and Adverse Reactions with Dapsone and Clofazimine.

Leprosy is a global health issue, causing long-term functional morbidity and stigma. Rapid diagnosis and appropriate treatment are important; however, early diagnosis is often challenging, especially in nonendemic areas. Here, we report a case of borderline lepromatous leprosy accompanied by dapsone-induced (neutropenia, anemia, and methemoglobinemia) and clofazimine-induced (skin discoloration and ichthyosis) side effects and type 1 leprosy reactions during administration of the multidrug therapy. The patient completely recovered without developing any deformities or visual impairment. To ensure early diagnosis and a favorable outcome, clinicians should be aware of the diminished sensation of skin lesions as a key physical finding and manage the drug toxicities and leprosy reactions appropriately in patients on multidrug therapy.

Childhood borderline lepromatous leprosy: a case report.

BACKGROUND: Leprosy in children is a strong indicator of the recent failure of leprosy control and disease transmission programs. For twenty-two years, leprosy has been declared `eliminated as a public health hazard,` yet new cases continue to emerge in endemic areas. The new case detection rate among the child population was recorded at 4.4 per million children. Because of their underdeveloped or neonatal immunity and exposure to intrafamilial contacts, children tend to be the most vulnerable population. CASE: We present a case of the borderline lepromatous type of leprosy in a 9-year-old Indonesian male patient with the chief complaint of three stiff fingers on his left hand that began four years ago and hypopigmented patches on the back and buttocks that began five years ago. In this case, there was a history of leprosy in his mother`s sister, who had died. Leprosy in the patient was suspected of possibly being transmitted from his mother`s sister who had intense contact with the patient. The results of bacteriological examination with Ziehl- Neelsen staining of tissue scrapings found acid-fast bacilli. He was treated with a multibacillary multidrug regimen for 12 months. Periodical observations after the patient received the treatment revealed no new spots on the patient`s skin, some of the previous hypopigmented patches seemed to fade, especially those on the back. CONCLUSIONS: In the absence of an effective vaccine, early diagnosis and treatment are critical in preventing disability and deformity and reducing the physical, psychosocial, and economic burden of the disease.

Type 2 Leprosy Reaction Mimicking Leukocytoclastic Vasculitis in a Postpartum Patient.

ABSTRACT: Leprosy is a disease caused by Mycobacterium leprae that, depending on a patient's baseline susceptibility and immune system function, can present in a wide variety of ways. The host's immune system response to the infection can be cell-mediated or humoral and can be further altered by changes in immune function or treatment. Depending on the time at which a skin biopsy is taken from affected areas, different inflammatory cell types are present, and the histopathology can mimic that of other infectious, autoimmune, or malignant entities, especially when the clinical information provided is vague. We present a case of a 24-year-old Micronesian woman who initially presented immediately postpartum with clinical and histopathological findings suggestive of urticarial vasculitis, but a subsequent biopsy resulted in a diagnosis of erythema nodosum leprosum reaction and borderline multibacillary leprosy. This case illustrates an unusual clinical and histological presentation of M. leprae and highlights the importance of clinical history.

Intermediate or Borderline forms (BT, BB, and BL)

Leprosy is a long-term spectrum disease and can present various clinical and histopathological aspects. Between the two poles of leprosy, there is a wide range of types, consisting of intermediate or borderline forms. In this chapter, the clinical, histopathological, and bacilloscopic characteristics of the intermediate forms (borderlibe-tuberculoid [BT], borderline-borderline [BB], and borderline lepromatous [BL]) are presented and discussed. The main clinical and pathological characteristics that allow the diagnosis and classification of leprosy among the different borderline forms are described and illustrated in panel form, as well as their most significant clinical and histopathological differential diagnoses are also discussed. The clinical-pathological classification of this disease has important implications in the choice of the correct treatment, the understanding of the pathophysiology, and the development of the reaction phenomena typical of leprosy,.

[Association of borderline tuberculoid leprosy and tuberculosis: A case report and review of the literature]. / Association d'une lèpre borderline tuberculoïde et d'une tuberculose : un cas et revue de la littérature.

INTRODUCTION: In metropolitan France, nearly 20 new cases of leprosy are diagnosed each year. The incidence of tuberculosis in France is 8/100,000 inhabitants and there are very few accounts of association of these two mycobacteria. Herein we report a case of co-infection with borderline tuberculoid (BT) leprosy and disseminated tuberculosis diagnosed in metropolitan France. PATIENTS AND METHODS: A male subject presented with diffuse painless infiltrated erythematous plaques. The biopsy revealed perisudoral and perineural lymphohistiocytic epithelioid cell granuloma as well as acid-alcohol-fast bacilli on Ziehl staining. PCR was positive for Mycobacterium leprae, confirming the diagnosis of leprosy in the BT form. The staging examination revealed predominantly lymphocytic left pleural effusion, right-central necrotic adenopathy without histological granuloma, negative screening for BK, a positive QuantiFERON-TB™ test, and a positive intradermal tuberculin reaction. The clinical and radiological results militated in favour of disseminated tuberculosis. Combined therapy (rifampicin, isoniazid, ethambutol and pyrazinamide) together with clofazimine resulted in regression of both cutaneous and extra-cutaneous lesions. This rare co-infection combines leprosy, often present for several years, and tuberculosis (usually pulmonary) of subsequent onset. The pathophysiological hypothesis is that of cross-immunity (with anti-TB immunity protecting against subsequent leprosy and vice versa), supported by the inverse correlation of the two levels of prevalence and by the protection afforded by tuberculosis vaccination. In most cases, treatment for TB and leprosy improves both diseases. Patients presenting leprosy should be screened for latent tuberculosis in order to avoid reactivation, particularly in cases where corticosteroid treatment is being given.

Lepra infantil. Presentación de tres casos / No disponible

La lepra en la infancia cursa con una diversidad de manifestaciones clínicas e histopatológicas que hacen necesario un minucioso examen cutáneo en todo niño, que presente lesiones dermatológicas sugestivas y una fuente infecciosa sospechosa. Para un oportuno diagnóstico es indispensable que el medico tenga siempre presente la enfermedad, así como la destreza al realizar el examen clínico, ya que muchas lesiones cutáneas suelen ser asintomáticas y con frecuencia simulan otros cuadros dermatológicos. El rango de edad en el cual la población infantil se encuentra más afectada está dentro de los 10 y 15 años. En la infancia la lepra refleja características clínicas del adulto, guardando ciertas particularidades; las formas paucibacilar son más comunes entre los dos y nueve años y las formas multibacilares entre los 10 a 14 años. En Cuba han sido reportados desde agosto de 1989 hasta diciembre 2016 un total de 135 casos de Lepra en pacientes en edad pediátrica de los cuales 44 (32,6 %), han sido atendidos en el Hospital Pediátrico Docente Juan Manuel Márquez. OBJETIVO: presentación clínica de tres casos de lepra infantil con formas clínicas diferentes. CONCLUSIONES: La lepra en la infancia cursa con una diversidad de manifestaciones clínicas e histopatológicas, que hacen necesario un minucioso examen cutáneo en todo nino, que presente lesiones dermatológicas sugestivas y una fuente infecciosa sospechosa. El mayor énfasis en la detección y vigilancia temprana de esta enfermedad se debe a que alguno de los niños que recientemente han sido diagnosticados ya mostraban signos de discapacidad

Leprosy in childhood presents a variety of clinical and histopathological manifestations that require a thorough skin examination in every child, presenting suggestive dermatological lesions and a suspicious infectious source. For a timely diagnosis it is essential that the doctor always keeps in mind the disease, as well as the knowledge for performing the clinical examination, since many skin lesions are usually asymptomatic and often simulate other dermatological conditions. The age range in which children are most affected is most affected is within 10 and 15 years. In childhood, leprosy reflects the clinical characteristics of the adult, keeping certain peculiarities; paucibacillary forms are more common between two and nine years old and multibacillary forms between 10 and 14 years old. In Cuba, a total of 135 cases of leprosy have been reported from August 1989 to December 2016 in pediatric patients, of which 44 (32.6%) have been treated at the Juan Manuel Marquez Teaching Pediatric Hospital. OBJECTIVE: clinical presentation of three cases of childhood leprosy with different clinical forms. CONCLUSIONS: Childhood leprosy has a variety of clinical and histopathological manifestations, which require a thorough skin examination in every child, presenting suggestive dermatological lesions and a suspicious infectious source. The greatest emphasis on the detection and early surveillance of this disease is due to the fact that some of the children who have recently been diagnosed already showed signs of disability

Erythroderma as a manifestation of leprosy.

Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.

Erythroderma as a manifestation of leprosy

Abstract: Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.

Mid borderline leprosy in type Bα Blaschko linear pattern: a rare phenomenon.

INTRODUCTION: Leprosy is a chronic granulomatous disease caused by M. leprae. It is a great imitator as it can manifest in different unusual and atypical ways. Mid borderline leprosy (BB) is an unstable form representing the immunologic midpoint in the clinical spectrum. CASE REPORT: Here, we report a case of BB leprosy having classical inverted saucer-shaped lesions elsewhere on the body with a linear psoriasiform lesion over the left forearm following the lines of Blaschko. Biopsy from this lesion revealed granulomas consisting of equal admixture of epithelioid cells and macrophages without multinucleate giant cells suggesting mid borderline leprosy. CONCLUSION: Occurrence of lesions in a Blaschko linear pattern supports the role of genetic susceptibility to leprosy. The genetically vulnerable cells along the lines of Blaschko were infected while the surrounding cells remained unaffected. This explains the concept of locus minoris resistentiae due to cutaneous mosaicism.

Diagnóstico tardío de lepra dimorfa. Presentación de un caso / No disponible

La lepra se considera una enfermedad granulomatosa, de evolución crónica, infecciosa, poco contagiosa, que afecta fundamentalmente piel y nervios periféricos, aunque puede afectar otras estructuras. La población masculina se ve afectada en mayor proporción que la población femenina a pesar de que la misma no distingue su aparición por sexo. Es una enfermedad que presenta manifestaciones clínicas muy variadas y que dependen de las respuestas inmunológicas del huésped y de su base genética. El diagnóstico temprano, realizado en el primer año de la aparición de los síntomas de la enfermedad, reviste la mayor importancia para el control de la misma. El presente artículo describe un caso de lepra dimorfa en un paciente de 38 años de edad, profesor de una escuela primaria rural con lesiones en cara y abdomen de más de dos años de evolución, constituyendo un diagnostico tardío de la enfermedad

Leprosy is considered a granulomatous disease, chronic, infectious, little contagious, affecting mainly skin and peripheral nerves, although it can affect other structures. The male population is affected in greater quantity than the female population. The disease presents varied clinical manifestations that depend on the immunological responses of the host and its genetic base. The early diagnosis, made in the first year of the appearance of the symptoms of the disease, is of great importance for its control. This article describes a case of dimorphic leprosy in a patient of 38 years of age, a teacher of a rural primary school with lesions on the face and abdomen of more than two years of evolution, constituting a late diagnosis of the disease

Erythema nodosum leprosum presenting as sweet's syndrome-like reaction in a borderline lepromatous leprosy patient.

Erythema nodosum leprosum (ENL) is characterized by tender erythematous nodules, accompanied by fever, malaise, arthralgia, and systemic complications. Atypical clinical manifestations have been reported such as pustular, bullous, ulceration; livedo reticularis; erythema multiforme-like reaction; and Sweet's syndrome (SS)-like presentation. We reported a case of ENL reaction presenting as SS-like reaction in a borderline lepromatous leprosy patient.