A Young Female With Borderline Lepromatous Leprosy and Tuberculous Lymphadenitis: A Rare Coinfection

Abstract

In Bangladesh, tuberculosis and leprosy are endemic mycobacterial diseases; however, co-infection is rarely seen. Our patient had a high-grade fever, symmetrical polyarthritis, polymorphous erythematous lesions, widespread lymphadenopathy, peripheral neuropathy, bilaterally thickened ulnar nerves, and claw hands. A lymph node biopsy revealed tuberculosis having acid-fast bacilli with caseating epithelioid histiocytic granuloma. Cutaneous lesions and sural nerve biopsies indicated borderline lepromatous leprosy. Fite-Faraco stain showed the presence of lepra bacilli in the biopsied sural nerve. Mantoux test showed 15 mm induration in 72 hours. Nerve conduction study (NCS) showed severe sensory-motor polyneuropathy (axonal) of all four limbs. Prednisolone and thalidomide for severe type-2 lepra response and category-01 antituberculosis medication and multidrug therapy for multibacillary leprosy improved the patient's condition. Bacille Calmette-Guérin (BCG) vaccination in the community might protect against tuberculosis and leprosy, thus reducing such coinfection. However, reduced cell-mediated immunity might promote latent tuberculosis reactivation or super-infection in individuals with multi-bacilli illnesses.

Keywords: coinfection; leprosy; severe neuropathy; tuberculosis; type 2 lepra reaction.

Figure 1. Polymorphous erythematous to violaceous lesions (arrows) in upper limb (A), lower limb (B), microscopic view of biopsied lymph node with Fite-Faraco stain showing globi of lepra bacilli (arrow) (C).

Figure 2. Nerve conduction study of upper and lower limbs with reduced amplitude (arrow).