A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis

Abstract

We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed.

Prospective study on antimicrobial resistance in leprosy cases diagnosed in France from 2001 to 2015

“…Dapsone resistance was mainly described in FT, where long-term dapsone was provided as monotherapy in the 1960s and 1970s [11]. Primary resistance to ofloxacin was observed, which may be explained by fluoroquinolone prescriptions provided for infections other than leprosy, as previously described [12]. Molecular detection of mutations in rpoB, folP1 and gyrA is today the best method to diagnose AMR in leprosy because drugresistant genotypes are highly concordant with mouse footpad assay phenotypes for rifampicin, dapsone and ofloxacin [7,13].…”

Population Genomics of Mycobacterium leprae Reveals a New Genotype in Madagascar and the Comoros

“…Leprosy was declared to be eliminated by the government of Madagascar in 2010, but the disease remains a public health problem, with more than 1,000 new cases reported annually since 2007 (Raharolahy et al, 2016;Suttels and Lenaerts, 2016;WHO, 2019). This is certainly an underestimate.…”

“…This is certainly an underestimate. Social exclusion and stigmatization are still common in Madagascar (Raharolahy et al, 2016), where approximately 25% of the new cases manifest with grade 2 disabilities, indicating late diagnosis (Raharolahy et al, 2016;Suttels and Lenaerts, 2016). Despite an efficient leprosy control program, the Comoros are still considered a highly endemic area, with a constant average of 400 new cases documented annually for an average population of 400,000 inhabitants since 2008 and 275 new cases in 2018 (Ortuno-Gutierrez et al, 2019;WHO, 2019).…”

“…However, the relapse rate is low and only 1.8% of new cases present with grade 2 disability (Hasker et al, 2017;Ortuno-Gutierrez et al, 2019). In the last report of the drug resistance surveillance network, resistance to rifampicin (rpoB), dapsone (folP1), and quinolones (gyrA) was observed only in three primary cases between 2009 and 2015 in Madagascar (Raharolahy et al, 2016;Cambau et al, 2018). No information is currently available for the Comoros.…”

Dermatophyte infection caused by Nannizzia gypsea : A rare case report from Madagascar

“…Indications of corticosteroid rely essentially on its anti-inflammatory, immunosuppressive and anti-allergic properties and should be targeted and monitored strictly to avoid adverse effects as observed in our case. In fact, misuse of topical [11] , [12] or injectable [13] corticosteroid is common in developing countries and presents a major threat to public health.…”