A very common case become rare: Anesthetic considerations of lepromatous leprosy

Abstract

Leprosy or Hansen's disease is very uncommon in developed countries. More than 80% of the world's cases occurs and still reported from developing countries. But nowadays due to increase in international affairs, medical tourism, globalization and immigration, there is increasing possibility to find patients anywhere, which require anesthesia for surgical interventions. Leprosy is a chronic infectious disease caused by Mycobacterium leprae and involves mainly skin, peripheral nervous system, upper respiratory tract, eyes and testes. Anesthetic consideration is focused mainly on complications related to leprosy like cardiac or respiratory dysautonomia, autonomic dysfunctions and side effects which are related to drug therapy and are challenging. There can be drug-related hepatitis and renal insufficiency in these patients. We report the anesthetic management of a patient with lepromatous leprosy who had undergone laparoscopic radical nephrectomy for renal cell carcinoma under general anesthesia.

Steroid Premedication Might Protect From Postoperative Erythema Nodosum Leprosum in Leprosy: A Case Report

“…Clofazimine-induced significant side effects are changes in skin color, rashes, itching, elevated blood sugar, retinopathy, nephrotoxicity, eosinophilic enteropathy, and cardiac arrhythmia [10]. Dapsone, a folate antagonist, has significant adverse effects, including hemolytic anemia, methemoglobinemia, agranulocytosis, abnormalities in liver function tests, jaundice, toxic or cholestatic hepatitis, peripheral neuropathy with primary motor function loss, psychosis, headache, dizziness, nausea, vomiting, dapsone hypersensitivity syndrome (DHS) [5,11]. DHS is a rare but life-threatening side effect of the drug characterized by fever, skin rash, leukemoid reaction, eosinophilia, thrombocytosis, lymphadenopathy, hepatic, pulmonary, and other systemic manifestations and requires immediate action [12].…”

“…While leprosy and lepra reaction cases are frequently encountered by dermatologists, as anesthesiologists, encountering these patients for some planned surgical procedure is rare and relatively scarce in the literature today [ 5 ]. Nevertheless, evidence of the perioperative lepra reaction and its prevention strategy is either absent or hardly reported.…”

General Anesthesia in a Patient with Leprosy: A Rare Case

“…Changes in drug metabolism and clearance as a result of hepatorenal dysfunction in leprosy causes prolongation of awaking period after anesthesia. 3 Drugs used for leprosy (Dapson, Rifampisin, Klofazimin) have multiple side effects that affect many systems. Dapson may cause hemolytic anemia, methemoglobinemia, agranulositosis, hepatitis, peripheral neuropathy, psychosis and leprosy reaction.…”

“…Sahu et al reported a successful general anesthesia administration to a leprosy patient with renal cell carcinoma. 3 There are also successful regional anesthesia methods in the literature. 15 Careful preoperative evaluation, sufficient perioperative preparation, close follow up and monitorization are important steps of anesthesia induction in leprosy patients with respiratory and cardiac dysautonomia.…”

“…Dysautonomia and side effects due to antileprotic drugs may lead multiorgan failure. 3 There are insufficient studies about anesthesia management patients with leprosy. In this case report, we aimed to present the management of general anesthesia in a patient followed up for leprosy and scheduled to undergo total thyroidectomy because of multinodular goiter.…”