Leprosy type-I reaction episode mimicking facial cellulitis-the importance of early diagnosis

Abstract

Leprosy is aneasily recognizable disease due to its dermato-neurological manifestations. It must be present in the physician’s diagnostic repertoire, especially for those working in endemic areas. However, leprosy reaction is not always easily recognized by non-dermatologists, becoming one of the major problems in the management of patients with leprosy, as it presents clinical complications characterized by inflammatory process, accompanied by pain, malaise and sometimes the establishment or worsening of the patient’s disabilities. We report the case of a patient with type-1 periorbital reaction admitted to the hospital, diagnosed and treated as facial cellulitis, whose late diagnosis may have contributed to the appearance or worsening of facial neuritis.

A Case of Lepromatous Leprosy (Lucio’s Phenomenon) Presenting as Periorbital Edema

“…After not improving on broad-spectrum antibiotics, histopathological assessment of the eyelid showed epithelioid and multinucleate giant cells and perivascular and periadnexal lymphocytic infiltrates, confirming borderline tuberculoid leprosy. Finally, Fernandes et al 23 described a case in Brazil of a 67-year-old man who had pruritus, edema, and erythema over the OS for 6 months with associated hand numbness. This patient was admitted for preseptal cellulitis and treated with broad-spectrum antibiotics, without clinical improvement over 10 days, at which time specimens from the periorbital skin showed periadnexal and perineural granulomatous changes, consistent with borderline tuberculoid leprosy.…”

Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018

“…Moreover, migrants may present with acute diseases such as malaria or with chronic infections that are much easier to suspect and diagnose such as tuberculosis, thus overshadowing the often much more subtle signs and symptoms of leprosy. Furthermore, leprosy can appear with other less common signs that can mimic other diseases [ 42 ]. This was also true for some of our patients who presented, for example, with edema of the face or the extremities, eye involvement, fever, arthritis, and lymphadenopathy, hardly attributable to leprosy.…”