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      Lepra Reactions: Mimickers and Mirror to Unmask Complex Cases of Leprosy

      case-report

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          Abstract

          Leprosy is a silent disease with protean manifestations, especially during lepra reactions (LRs). Cases with atypical leprosy or LR simulate a number of conditions misdiagnosed frequently. Here, three classical cases of leprosy are reported for their complex presentation. Leprosy was hidden in Case 1 due to co-existing diabetes. COVID vaccination induced LR unmasked all leprosy lesions, which were extensive, large, bizarre and spreading to various immune zones. Case 2 presented with high-grade fever, tachycardia, generalized erythema and body aches. A detailed workup unveiled his leprosy with a rare presentation of Type 1 lepra reaction (T1LR) with erythroderma and severe systemic symptoms. Case 3 mimicked sarcoidosis and lupus erythematosus (LE) on routine workup. She had facial lesions in the malar area, photosensitivity, joint pains, raised angiotensin-converting enzyme (ACE) levels and positive anti-nuclear antibodies. Peri-appendageal granulomas on histopathology and therapeutic response to multidrug therapy helped in the early diagnosis of leprosy.

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          Diabetic status of patients with leprosy in Kuwait.

          Lama A. Qasem, K. A. Saraya, H A Fadhli (2012)
          The aim of this study was to screen for diabetes mellitus in leprosy patients to elucidate whether leprosy infection may play a role in the pathogenesis of diabetes mellitus in this population. Thirty patients of different ages and of both sexes with various types of leprosy were included in this study. In addition, 15 healthy individuals of comparable age and sex who had no family history of diabetes mellitus were identified as controls. In both groups, determinations of fasting and postprandial blood sugar, an oral glucose tolerance test (OGTT), measures of fasting serum insulin and pro-inflammatory cytokine tumor necrosis factor alpha (TNFα), as well as calculations using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), were carried out. Approximately 13.3% of the leprosy patients were diabetic, and 37.7% were in pre-diabetic. The highest incidences of diabetes and pre-diabetes were in lepromatous leprosy (10% and 20%, respectively); a lower incidence of pre-diabetes (6.6%) was observed in tuberculoid leprosy; and the lowest incidence of diabetes (0.0%) was noted in borderline leprosy patients. Although normal healthy persons were not diabetic (0%), 20% were pre-diabetic. This study revealed that the incidence of diabetes was higher in the leprosy patients than in the control group. As a result, we recommend that all leprosy patients should be screened for diabetes. Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
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            Diabetic status in leprosy.

            P Nigam, S G Dayal, P. Srivastava … (1979)
            The diabetic status of the local Jhansi patients (120 cases) was established before and after antileprosy treatment. Control studies were performed in normal healthy subjects (50 persons) without family history of diabetes mellitus. Random normals showed an incidence of diabetes only 2%, while leprosy patients (94 males and 26 females) had incidence of diabetic status of 14.2%. The highest incidence (19.3%) of diabetes was in lepromatous leprosy and lowest incidence (6.4%) in tuberculoid leprosy patients. Repeated studies in leprosy after treatment showed not only clinical improvement for leprosy but also disappearance of the chemical and latent diabetes mellitus and lowering of blood sugar levels in manifest diabetes mellitus. Incidentally it was noted that 'diabetic status' was worse among males (82.3%) and with advancing age. Association and improvement of diabetic status with specific treatment would tentatively suggest that Mycobacterium leprae lesions are not confined to skin alone but somehow also related to carbohydrate metabolism. A careful management of the chemical and latent diabetes may help in clinical management of leprosy too.
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              Leprosy Masquerading as Systemic Rheumatic Diseases.

              Hala El-Gendy, Rasmia El-Gohary, Kyrillus Shohdy … (2016)
              Rheumatologic manifestations not only are encountered in leprosy but also can be the first and even the sole presenting manifestation. The hallmark of leprosy is skin and peripheral nerve affection; however, it can affect a wide range of other organs, with the joints being the commonest. We have searched PubMed with the key words leprosy, arthritis, vasculitis, rheumatic diseases, and autoantibodies in a proper combination. Relevant studies were retrieved from scanning of their abstracts. The relevant references provided in these articles were also selected and reviewed. We summarize the clinical and laboratory manifestations that make leprosy masquerade as a systemic rheumatic disease. Moreover, we report 4 Egyptian patients who presented with rheumatologic manifestations, namely, arthritis and vasculitis that turned out to be leprosy related.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian Dermatol Online J
                Journal ID (iso-abbrev): Indian Dermatol Online J
                Journal ID (publisher-id): IDOJ
                Journal ID (publisher-id): Indian Dermatol Online J
                Title: Indian Dermatology Online Journal
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 2229-5178
                ISSN (Electronic): 2249-5673
                Publication date Collection: May-Jun 2024
                Publication date (Electronic): 24 November 2023
                Volume: 15
                Issue: 3
                Pages: 500-503
                Affiliations
                [1] Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
                Author notes
                Address for correspondence: Dr. Sandhya Kumari, Dermatology, IGMC, Shimla - 171 001, Himachal Pradesh, India. E-mail: drsandhya069@ 123456gmail.com
                Article
                Publisher ID: IDOJ-15-500
                DOI: 10.4103/idoj.idoj_294_23
                PMC ID: 11152462
                PubMed ID: 38845657
                SO-VID: a78343ae-7e08-4bfc-b834-84f38101cd9a
                Copyright © Copyright: © 2023 Indian Dermatology Online Journal
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 16 April 2023
                Date revision received : 08 July 2023
                Date accepted : 13 July 2023
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: atypical,leprosy,mimicker
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: atypical, leprosy, mimicker

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