Borderline Lepromatous Leprosy with Type 1 (Reversal) Reactions in a Chinese Man

• Published in: The American journal of tropical medicine and hygiene Vol. 93; no. 2; pp. 207 - 209
• Main Authors: Fu, Xi'an, Liu, Hong, Zhang, Furen
• Format: Journal Article
• Language: English
• Published: United States The American Society of Tropical Medicine and Hygiene 01-08-2015
• Subjects: Clofazimine - therapeutic use; Dapsone - therapeutic use; Humans; Images in Clinical Tropical Medicine; Leprostatic Agents - therapeutic use; Leprosy, Borderline - diagnosis; Leprosy, Borderline - drug therapy; Leprosy, Lepromatous - diagnosis; Leprosy, Lepromatous - drug therapy; Male; Middle Aged; Mycobacterium leprae; Mycobacterium leprae - isolation & purification; Rifampin - therapeutic use
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.14-0491

A 59-year-old man diagnosed with borderline lepromatous leprosy developed reddish patches and plaques on the face, which progressively enlarged and spread to the trunk and limbs (Figure 1A-D). Other superficial nerves appeared normal. Biopsy showed plasmocytic and lymphocytic infiltration in the nerve tract, and was 4+ acid-fast bacilli (AFB)-stain positive suggesting Mycobacterium leprae (Figure 2A and B); this was confirmed by real-time polymerase chain reaction (PCR). The HLA-B*13:01 test was negative. Two weeks after rifampin, dapsone, and clofazimine (World Health Organization multidrug therapy [WHOMDT] regimen) were started, the skin lesions (hypochromic macules) became red, edematous, and enlarged (Figure 3A-D).