Lepromatous Leprosy

A 27-year-old woman from the Maluku province of Indonesia presented with erythematous skin lesions that had progressed slowly during the preceding 2 years. The lesions started initially as macular discoloration of the cheeks but evolved into indurated, erythematous plaques involving the entire face, trunk, and bilateral upper and lower extremities. The patient also experienced flattening of the nasal bridge and loss of bilateral eyebrows. The lesions on the extremities were associated with numbness and swelling of the hands and feet. The patient had palpable, nodular thickening of ulnar and sural nerves and diffuse skin changes. Biopsy of the right earlobe and sural nerve showed granulomatous inflammation. Numerous acid-fast organisms were seen on Fite method and auramine-rhodamine stains, suggestive of multibacillary (lepromatous) leprosy. Electromyographic findings indicated axonal length-dependent sensorimotor peripheral neuropathy. A treatment regimen of clofazimine, dapsone, and rifampin was initiated, with a planned duration of 2 years. The patient was doing well at 2-month follow-up. Despite attempts at eradication, leprosy (Hansen disease) remains endemic in certain parts of the world, including Indonesia, India, and Brazil.1Leprosy: global target attained.Wkly Epidemiol Rec. 2001; 76: 155-156PubMed Google Scholar The causative organism is Mycobacterium leprae, an obligate intracellular parasite.2Ishii N Recent advances in the treatment of leprosy.Dermatol Online J. 2003; 9: 5PubMed Google Scholar Clinical presentations range from paucibacillary (tuberculoid) disease with less than 5 lesions to multibacillary (lepromatous) leprosy with diffuse skin involvement of the face, trunk, and extremities.3WHO Expert Committee on Leprosy World Health Organ Tech Rep Ser. 1998; 874: 1-43PubMed Google Scholar Severe involvement of facial skin results in the classic “leonine” face seen in our patient. Both sensory and motor nerve damage occur in the vicinity of tuberculoid lesions but can be more diffuse in lepromatous leprosy.4Jacobson RR Krahenbuhl JL Leprosy.Lancet. 1999; 353: 655-660Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar With treatment, the skin lesions gradually clear, mostly within the first year.