Leprosy – eliminated and forgotten: a case report

Abstract

Background Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

Fever of Unknown Origin - A Child With an Unusual Case of Juvenile Idiopathic Arthritis

“…Study done by Chow et al in several developing countries showed infection the most common cause compared to other cause such as malignancy (2%-12%), collagenvascular (2%-21%), miscellaneous noninfectious (2%-50%), and unknown (12%-29%). 2,3 Since the child had a history of weight loss, low-grade fever for months, TB was one of the differential diagnoses. Positive Mantoux test and high ESR further strengthened the possibility of TB.…”

Lepra: sospecha diagnóstica en área no endémica. Serie de casos y revisión de la literatura

“…El diagnóstico de lepra en áreas no endémicas suele ser dificultoso, ya que la sospecha clínica no es de primera intención. La OMS ha facilitado lineamientos que puedan facilitar la presunción diagnóstica, entre los que se encuentran: (i) pérdida sensitiva permanente de un área hipopigmentada o eritematosa, (ii) engrosamiento de un nervio periférico asociado a pérdida sensitiva, o (iii) presencia de bacilos ácido-alcohol resistentes en un frotis de piel raspada [6,7] .…”