Leprosy - eliminated and forgotten: a case report

Abstract

Background: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual.

Case presentation: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still's disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication.

Conclusion: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

Keywords: Erythema; Mycobacterium; Nodosum; Still.

Fig. 1

Photomicrograph showing patchy infiltration by epithelioid cells and lymphoid population along with foam cells and neutrophils. The infiltration was mainly limited to perineural and around the sweat glands and arrector pili muscles. (Hematoxylin stain; × 100)

Fig. 2

High-power view showing perineural infiltration by inflammatory cells. (Hematoxylin stain, × 400)

Fig. 3

Photomicrograph showing several clusters of lepra bacilli (Wade Fite stain; × 1000)