P.137 A case of leprosy in the UK

Abstract

Introduction: Leprosy is a multi-system disease caused by Mycobacterium leprae. Whilst uncommon in the developed world, cases continue to rise in developing nations with up to 200,000 new cases reported annually. 1We report a case of lepromatous leprosy in a parturient residing in Scotland. Case Report: A 26-year-old primigravida presented in early pregnancy following a history of nosebleeds and widespread rash. The patient was a sickle-cell carrier but was otherwise well with no allergies. A diagnosis of lepromatous leprosy with erythema nodosum reaction was made and treatment commenced with prednisolone and combination therapy with rifampicin, clofazimine and dapsone. The pregnancy was complicated by anaemia and thrombocytopaenia with mild splenomegaly. Anaemia was thought to be secondary to Dapsone-related haemolysis, and thrombocytopaenia was thought most likely to be gestational. She developed neuropathic leg pain and hypoaesthesia but this resolved during the pregnancy. Renal and liver function remained normal and there were no symptoms or signs of autonomic dysfunction with normal postural blood pressure readings and normal ECG. After multi-disciplinary discussion, induction of labour was planned due to concerns over fetal growth. The patient was screened for SARS-CoV-2 and this was positive, though the patient remained asymptomatic. The patient was not considered to be infectious and standard infection control procedures were observed. Anaesthetic options for analgesia in labour and anaesthesia for potential operative delivery were discussed at several occasions during pregnancy and ”OAA Labour Pains” translated information sheets were given to the patient. Following induction of labour, the patient had a spontaneous vaginal delivery with no anaesthetic intervention required. Discussion: Leprosy is uncommon in developed nations but may occur in the UK as the population becomes more diverse. Leprosy raises many potential challenges for the anaesthetist including;cutaneous changes (which may be of particular significance if occurring over sites of intravenous access or lower lumbar region), neuropathies, myopathies, autonomic dysfunction, haematological derangements (including anaemia, thrombocytopaenia and agranulocytosis) and liver and renal impairment. Drug therapies for leprosy may in themselves be associated with blood dyscrasias, hepatitis, psychosis, and peripheral neuropathies. Anaesthetic management should be informed by the presence of any complications, most notable thrombocytopaenia or peripheral neuropathies. The possibility of autonomic dysfunction should be considered regardless of which anaesthetic modality is chosen and care taken to actively manage hypotension. The patient’s SARS-CoV-2 status was a further factor influencing the risk-benefit assessment of anaesthetic options in this case.