Abstract
Leprosy (Hansens disease) is a chronic granulomatous infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues. It is diagnosable and curable if recognized early and treated adequately. A twenty nine-year-old male from Jessore, Bangladesh reported in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of multiple erythematous, large, raised and circumscribed lesions with loss of sensations on different parts of the body, especially distal portions of all four limbs for last eight months. Subsequently he developed ulcers on the anesthetic fingers due to smoking and few ulcerative lesions on both feet. Skin examination revealed multiple erythematous, large nodular lesions on both sides of the cheek and forehead, multiple erythematous, indurated, large plaques with raised margin and central clearing on the trunk, waist and all four limbs, few satellite lesions around the large plaques on the trunk, few hypopigmented patches and plaques on buttock and lower limbs, multiple painless ulcers on dorsal surface of fingers of both hands, both lateral malleoluses and right sole. On examination of peripheral nerves, left great auricular nerve, both ulnar nerves and both common peroneal nerves were moderately enlarged and tender. Slit skin smear for AFB (modified Z-N stain) was done and revealed that there were large number of acid and alcohol-fast bacilli arranged in straight and curved parallel bundles with globular masses (cigar-bundle appearance), morphologically resembling Mycobacterium leprae. Skin biopsy for histopathological examination revealed extensive infiltration of macrophages in the dermis, separated from epidermis by narrow grenz zone, with destruction of skin adnexa. Few foci of poorly defined granuloma in dermis were also noted. The patient was managed with rifampicin, clofazimine, dapsone, prednisolone and omeprazole. Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 109-112 DOI: http://dx.doi.org/10.3329/jemc.v3i2.16134
Highlights
Leprosy (Hansen’s disease) is a spectrum disease characterized by a variety of abnormal immune response, that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues
The lesions are symmetrical, numerous, and may include macules, papules, plaques and nodules.[2]. This patient’s lesions were symmetrical and morphologically similar which support the criteria of borderline lepromatous leprosy
Sensation and sweating over individual lesions are normal.[2]. This patient’s sensation and sweating over different types of lesions were normal. The findings of this case are consistent with typical presentation of borderline lepromatous leprosy
Summary
Leprosy (Hansen’s disease) is a spectrum disease characterized by a variety of abnormal immune response, that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues. It is diagnosable and curable if recognized early and treated adequately.[1] The causative agent is Mycobacterium leprae which was first identified in 1873 by the Norwegian bacteriologist Gerhard Henrik Armauer Hansen.[2] It occurs at all ages but more common in between 10-. It depends on the integrity of the host’s specific cell mediated immunity (CMI) response to the M leprae and it may be genetically determined.[10]
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