Three Indigenous Cases of Leprosy in the Mississippi Delta

John M. Abide, MD; Risa M. Webb, MD; Harriet L. Jones, MD; LaFarra Young, MD

Disclosures

South Med J. 2008;101(6):635-638. 

In This Article

Case Reports

The first patient, a 78-year-old white male, presented on routine examination with two 2-cm erythematous asymptomatic nodules on his mid back (Fig. 1). They were painless and showed no loss of sensation to a cotton wisp. Biopsy of both nodules revealed granulomatous dermatitis with acid-fast bacteria (AFB) (Fig. 2). The patient had no known exposure to leprosy patients, and had never traveled to an endemic country. He remembered having killed an armadillo under his house a few years before and was exposed to its blood on his hand when removing the animal. Fungal culture, chest radiograph, tuberculin skin test (TST), and sputum showed no evidence of tuberculosis. Two 5-mm punch biopsies were sent to the National Hansen's Disease Program (NHDP) in Baton Rouge, LA. They reported moderate AFB, confirmed with a polymerase chain reaction as M. leprae and diagnosed him as having Hansen disease in the borderline spectrum. He was placed on rifampin 600 mg/d and dapsone 100 mg/d for 1 year and responded well, with total resolution of the nodules on his back.

Patient 1, initial presentation with asymptomatic erythematous nodules of back.

Patient 1, arrow indicating acid-fact bacteria (Fite-Faraco stain; original magnification, ×1,000 with oil).

The second patient was an 81-year-old white female who presented with a 3-week history of a growth on her left upper arm that had itched initially. The patient reported problems with armadillos digging in her flower beds which she often tended. She also reported a history of once eating armadillo meat about 30 years ago. She had no known exposure to a leprosy case or travel to an endemic country. Examination revealed a 2-cm well-defined skin-colored plaque with an erythematous margin. No epidermal change or loss of sensation was noted to a cotton wisp. A 4-mm punch biopsy revealed a granulomatous dermatitis with AFB. Sputum, chest radiograph, and TST showed no evidence of tuberculosis. The lesion was sent to the NHDP where the patient was diagnosed with borderline tuberculoid leprosy, and treated with dapsone 100 mg and rifampin 600 mg daily. At 3-year follow-up, she remains free of recurrence.

The third patient was a 73-year-old white male who presented with a macular, generalized, erythematous eruption of 2 months' duration that was accompanied by a burning sensation (Fig. 3). He did not feel acutely ill, but did report vague shooting pains down his arms and legs at times. His medications included niacin, warfarin, atorvastatin, amiodarone, and brimonidine ophthalmic. The patient gave a history of frequent exposure to armadillos, including killing one and getting blood on his hands when he disposed of it. A biopsy of his abdomen revealed granulomatous dermatitis with AFB that focally involved nerves (Figs. 4 and 5). He was evaluated at the NHDP. Some loss of plantar sensation was noted on physical examination with monofilaments, and skin smears from six sites showed 3+ acid-fast bacilli. Neurologic testing revealed no significant nerve damage. He was diagnosed by the NHDP as having borderline lepromatous leprosy, active, and was placed on clofazimine 50 mg/d, dapsone 100 mg/d, and rifampin 600 mg/mo.

Patient 3, borderline lepromatous leprosy presenting as macular erythematous generalized rash, anterior trunk.

Patient 3 borderline lepromatous leprosy skin biopsy with nerve involvement (hematoxylin and eosin stain; original magnification, ×200).

Patient 3, skin biopsy with acid-fast bacilli indicated by arrow (Fite-Faraco stain; original magnification, ×1,000 with oil).

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....