Bilateral ptosis/blepharitis due to lepromatous leprosy

Abstract

Purpose To underscore the importance of histopathological evaluation in cases presenting with a constellation of unusual ocular inflammation and physical findings. Observation A 51-year-old male, presented with a chief complaint of worsening visual field loss due to droopy eyelids two months post excision of a right upper eyelid squamous cell carcinoma. His past medical history included chronic edematous facial features, chronic sinusitis, unexplained peripheral neuropathy, and worsening fatigue. Pre-blepharoplasty work-up revealed mechanical ptosis from lid edema, madarosis, a concave nasal bridge, pancytopenia, and numerous burn marks due to inadvertent injuries. Bilateral blepharoplasty was performed, and the excised tissue submitted for histopathological evaluation that revealed non-caseating granulomatous perineural inflammation with numerous acid-fast bacilli in dermal layers and nerves. These findings prompted a diagnosis of lepromatous leprosy with suspected bone marrow involvement. The source of the infection was unknown. The blepharoplasty restored his visual fields and multi-drug therapy (MDT) improved his general health and wellbeing with concomitant reductions of pancytopenia, fatigue, and facial edema. Conclusions and importance Biopsy histopathology, in patients with longstanding ocular adnexal inflammation, can facilitate diagnosis and treatment. To the authors’ knowledge, this is an unusual ocular leprosy presentation and represents the first leprosy case diagnosed via blepharoplasty.

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

“…To our knowledge, only a few other leprosy cases have been reported as presenting in this fashion. Iqbal et al 21 reported a case of a 51-year-old man presenting with chronic bilateral ocular adnexal inflammation, eyelid swelling, ptosis, and blepharitis for 1–2 years in the United States. He was found to have lepromatous leprosy after histopathological evaluation showed noncaseating granulomatous perineural inflammation and acid-fast bacilli in the eyelid specimens.…”

Leprosy Classification, Clinical Features, Epidemiology, and Host Immunological Responses: Failure of Eradication in 2023

“…Neuronal injury in leprosy may present as weakness or may result in silent neuropathy, contracture, or atrophy [ 7 , 8 ]. Stocking and glove pattern of sensory damage is seen toward the lepromatous pole [ 9 , 10 ].…”