Postpartum sepsis-like illness and rash associated with Hansen’s disease

Jinai Bharucha,Lynne Saito-Tom

doi:10.1515/crpm-2021-0046

Abstract

Abstract Objectives Hansen’s disease (HD) often manifests during pregnancy and the postpartum. Patients with HD may experience reactions that mimic other conditions making diagnosis challenging. Case presentation We present a case of a patient from Chuuk, a state of the Federated States of Micronesia with a sepsis-like illness and worsening painful rash immediately postpartum. Antepartum, the patient noted a pruritic rash on her legs. Four hours after delivery, the patient became febrile and later developed systemic inflammatory response syndrome (SIRS). The rash rapidly spread to other areas of her body and became painful and edematous. Eight weeks after delivery, a skin biopsy revealed tuberculoid granulomatous dermatitis consistent with HD. Conclusions HD and its associated reactions are easily misdiagnosed. Performing a skin biopsy of unusual skin lesions or common skin lesions with severe illness in a pregnant patient can expedite diagnosis of rare conditions such as HD. Early initiation of treatment for HD and its reactions are critical to prevent serious nerve damage and permanent disability.

Highlights

Hansen’s disease (HD), known as Leprosy, affects four million people worldwide and is a chronic granulomatous infectious disease caused by Mycobacterium leprae [1]
Case presentation: We present a case of a patient from Chuuk, a state of the Federated States of Micronesia with a sepsis-like illness and worsening painful rash immediately postpartum
We suspect that the postpartum systemic illness and painful rash were likely a Type 2 Erythema Nodosum Leprosum reaction caused by the depression of the cellmediated immune system in pregnancy

Summary

Introduction

Hansen’s disease (HD), known as Leprosy, affects four million people worldwide and is a chronic granulomatous. Its primary presenting symptom, have a broad differential diagnosis in pregnancy. The diagnosis of HD requires a skin biopsy [5]. Acute hypersensitivity or immunological reactions occur in up to 50% of all patients. These reactions can be confused with cellulitis, drug eruptions, tumid lupus, sepsis, and a systemic connective tissue disease flare [5]. Nerve damage will lead to deformity and disability. Patients may have nerve damage or neuritis at time of diagnosis, prompt treatment is imperative to prevent further damage and sometimes to even reverse damage. 30–40% of patients will have possible additional nerve damage caused by reactions during treatment.

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Case presentation

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Discussion