A Case of Lepromatous Leprosy with Type 2 Lepra Reaction and Multidrug-Resistant Tuberculosis: Diagnostic and Therapeutic Challenges
Main Article Content
Abstract
Background: Leprosy, caused by Mycobacterium leprae, is a chronic infectious disease often complicated by immune-mediated reactions. Type 2 lepra reaction, or erythema nodosum leprosum (ENL), is characterized by systemic inflammatory symptoms requiring immunosuppressive therapy. Co-infection with multidrug-resistant tuberculosis (MDR-TB) further complicates management and prognosis.
Case Presentation: A 35-year-old male presented with abdominal pain, loose stools, vomiting, and dusky erythematous skin lesions. He was diagnosed with lepromatous leprosy and initiated on multidrug therapy. Subsequently, he developed ENL manifesting as flared-up lesions, facial puffiness, and small joint pain, necessitating corticosteroid treatment. Two months later, he was diagnosed with MDR-TB with right-sided pleural effusion and lung collapse, which was successfully managed with a Bedaquiline-based regimen.
Conclusion: This case highlights the diagnostic and therapeutic challenges posed by the coexistence of leprosy, ENL, and MDR-TB. Early recognition, multidisciplinary care, and integrated management strategies are essential for achieving favourable outcomes in such complex presentations.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. World Health Organization. (2024). Leprosy: Key facts. Retrieved from https://www.who.int/news-room/fact-sheets/detail/leprosy.
II. Jadhav, S. K., & Kar, S. K. (2020). Lepra reactions: A review of the pathophysiology and management. Indian Journal of Dermatology, Venereology and Leprology, 86(6), 577-585.
III. Global Tuberculosis Report. (2024). World Health Organization. Retrieved from
https://www.who.int/teams/global-tuberculosis-programme.
IV. Nunn, A., & Gonzalez, M. (2019). Multidrug-resistant tuberculosis: Current treatment options. Journal of Clinical Infectious Diseases, 68(4), 564-571.
V. Peppé, S. M., & Ramos, L. D. (2021). Steroid-induced complications in leprosy: A clinical review. Journal of Leprosy and Tropical Medicine, 19(2), 142-148.
VI. World Health Organization. (2022). Guidelines for the programmatic management of drug-resistant tuberculosis. WHO/HTM/TB/2022.6. Retrieved
from https://www.who.int/publications/i/item/9789240064393.
VII. Lazzarini, L., & Labarre, A. (2020). Immunological mechanisms in type 2 lepra reaction (erythema nodosum leprosum). The International Journal of Dermatology, 59(11), 1360-1366.
VIII. Turel, O., & Ghatak, S. (2021). Clinical and histopathological findings in lepromatous leprosy: Case-based review. Clinical Pathology, 44(4), 220-226.
IX. Dholakia, M., & Shinde, M. (2022). Treatment strategies for leprosy and leprosy reactions. Journal of Clinical Infectious Diseases, 58(7), 872-880.
X. Agarwal, R., & Sharma, S. (2020).
Multidisciplinary management of drug-resistant tuberculosis. Journal of Pulmonary Medicine, 45(3), 105-112.
XI. Bedaquiline Monotherapy for Multibacillary Leprosy, Jaison Barreto et all, N Engl J Med 2024;391:2212-8. DOI: 10.1056/NEJMoa2312928