Abstract
We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed.
Highlights
Leprosy is a chronic infectious disease caused by Mycobacterium leprae that commonly affects skin and peripheral nerves
We describe a case of misdiagnosed typical lepromatous leprosy caused by a secondary fluoroquinolone-resistant strain in a patient with probable drug-induced immunosuppression
The systemic administration of corticosteroid over a 4-year period without etiological treatment has worsened the lack of cellular immune response
Summary
Leprosy is a chronic infectious disease caused by Mycobacterium leprae that commonly affects skin and peripheral nerves. The diagnosis of leprosy is not always easy due to the great diversity of clinical manifestations, which depend mainly on the patient’s cellular immunity to Mycobacteria [1], and on his immune status and genetic factors [2]. Whereas the prevalence of leprosy has been significantly reduced in most endemic areas, its incidence has remained steady for the past decade. In Madagascar, where leprosy is considered a major public health concern [3], more than 1,000 new cases were reported annually from 2005 to 2014. Major challenges still remain including the emergence of drug-resistant strains of M. leprae. We describe a case of misdiagnosed typical lepromatous leprosy caused by a secondary fluoroquinolone-resistant strain in a patient with probable drug-induced immunosuppression
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