Clinical case. Borderline leprosy in reaction in a boy

  Leprosy Mailing List – March 28th, 2012 

Ref.:   Clinical case. Borderline leprosy in reaction in a boyFrom: P. Vijayakumaran, Chennai, India

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Dear Salvatore,

I refer to the clinical case circulated by via the Leprosy Mailing List – March 24th, 2012.  Thank you very much to Dr Barreto and Dr Cabral for sharing the interesting case history (not so interesting for the person affected).  I congratulate the team for providing all details for better understanding of the situation and also appropriate management of the condition. I am not a pathologist.  Here are my impressions:

·         The presentation was atypical so that it could not be related to leprosy.

·         Health staff are not aware of presentations of leprosy.

·         Leprosy referral hospital may have un-trained staff who cannot identify leprosy.

·         Multiple nerve involvement is characteristic of borderline leprosy.  That too with in a period of one year goes more in favour.

·         Bacteriological Index of 2+ at all sites (probably all selective sites – that means active lesions) may indicate that the disease has progressed beyond borderline tuberculoid leprosy (towards lepromatous leprosy).

·         Biopsy - 3+ positive and presence of globi are indicative of lepromatous side of leprosy spectrum.

·         Biopsy – Globi and macrophages are characteristics of lepromatous side of the spectrum.

Fig.1 & 2               : Any trained eye will suspect leprosy.

Fig.3 & 4               : Misleading presentation because of scaling and central healing.

Fig.5, 6 & 7          : Trained eyes should be able to suspect leprosy.

Fig.8                    : Explains importance of examination of peripheral nerves. Again trained eyes and hands comes to my mind.

Fig.15 & 16          : Clearly clinical presentation of BB leprosy. 

This child is fortunate to have intact nerve function. This also warrants close observation for possibility of fresh episodes of reactions and especially neuritis. 

I once again thank the authors and the LML for sharing their experience. 

With best wishes,

Dr.P.Vijayakumaran,

Regional Medical Coordinator South,

German Leprosy and TB Relief Association India,

#4, Gajapathi street, Shenoy Nagar,

Chennai – 600030, India