Korean Lepr Bull.  2019 Dec;52(1):55-61. 10.33161/klb.2019.52.1.55.

Relapsed Leprosy with Multiple Ulcerative Skin Lesions: A Case Report

• Jeong HH
• Hong SG
• Park JM
• Kim JP
• Heo EP
• Go JW

• KMID: 2466493
• DOI: http://doi.org/10.33161/klb.2019.52.1.55

Abstract

Leprosy is a chronic infectious and granulomatous disease caused by Mycobacterium leprae. It is treated with a multidrug therapy (MDT), which is consisted of dapsone, rifampicin, and clofazimine. However, there were relapsed leprosy associated with various predisposing factors; persisting organism, multiple involved skin lesions and nerves, HIV infection, monotherapy, inadequate and irregular therapy. Early or late relapses were observed in leprosy. Early onset relapses may occur due to insufficient treatment, and late relapses are probably with persistent bacilli and drug resistant organisms. Herein, we report on an interesting case of a 78-year-old man presented with relapsed leprosy associated with ulcerative skin lesions. The patient was diagnosed with lepromatous leprosy about 40 years ago, and he was treated with dapsone monotherapy and MDT. Our case is thought to have occurred due to persistent bacilli related to irregular therapy.

Keyword

Leprosy; Relapse

MeSH Terms

Aged
Causality
Clofazimine
Dapsone
HIV Infections
Humans
Leprosy*
Leprosy, Lepromatous
Mycobacterium leprae
Recurrence
Rifampin
Skin*
Ulcer*
Clofazimine
Dapsone
Rifampin

Figure

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  Fig. 1 (A) Erythematosus plaques with ulcerative skin lesions on the trunk (B) Multiple painful ulcers on the chest

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  Fig. 2 Histopathologic examination shows diffuse inflammatory cell infiltration in dermis (A) and subcutis (B) separated from subepidermal grenz zone (H&E, ×40), and also positive staining with acid-fast bacilli stain (×400) (C)

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  Fig. 3 PCR results show positive band on 157 bp. Lane (A) sample of tissue; (B) sample of tissue; (C) sample of paraffine; (D) positive control; (E) negative control.

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  Fig. 4 After treatments, skin lesions on chest (A) and lower back (B) were showed scarring changes with crusts.

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