Leprosy in a Renal Transplant Recipient: A Case Report and Literature Review

Abstract

Leprosy is rarely seen in organ transplant patients; only ten cases of leprosy in organ transplant recipients have been reported. We herein report a Taiwanese renal transplant recipient concomitantly infected with borderline lepromatous leprosy. A 68-year-old male received renal transplantation at Guilin, China, in 2000, and then received immunosuppressive therapy with prednisolone, tacrolimus, and mycophenolate. Three years after transplantation, multiple erythematous tender nodules and plaques over the face and lower limbs developed. Biopsies and histopathological examination confirmed the diagnosis of leprosy. We treated the patient with a multidrug regimen including dapsone, clofazimine, and rifampine since November of 2003 with a good response. Unfortunately, he suffered from a cluster of complications after an accidental fall, finally leading to septic shock and death five months later. In summary, we report a rare case of new-onset leprosy after renal transplantation in Taiwan and suggest leprosy should be listed in the differential diagnosis of unusual skin manifestations in organ transplant patients.

Six cases of leprosy associated with allogeneic hematopoietic SCT

“…Leprosy has been described in association with kidney or heart transplantation [8][9][10][11][12][13][14][15][16][17][18] and with other immunosuppressive conditions like AIDS and cancer, [19][20][21] but not with SCT. In the cases we presented, this association occurred like de novo opportunistic infection (cases 1-3), reactivation of the disease after SCT (case 4) and simultaneous occurrence of a potentially transplantable disease with leprosy before SCT (cases 5 and 6).…”

“…8,10,11,13 The remaining 11 cases, including the two that occurred in heart transplant recipients, presented with de novo opportunistic mycobacterium infection from 5 months to 12 years after transplantation. 9,12,[14][15][16][17][18] Unlike SCT, in solid organ transplants (SOT), no conditioning regimen is used and post transplant immunosuppressive drugs are continued for life, in different doses and schedules, to prevent rejection or to treat episodic rejection of the transplanted organ, and no GVHD is expected to occur. Moreover, in SCT, the immune reconstitution has been found to be influenced by the source of graft (PBSC vs BM), CMV reactivation after the SCT and the use of anti-thymocyte globulin in unrelated transplants.…”

“…[28][29][30][31] In the literature, there are 18 cases of leprosy in renal transplant recipients and two cases in heart transplant recipients. [8][9][10][11][12][13][14][15][16][17][18] Nine renal transplant recipients were infected with M. leprae before transplantation. Two patients had active lesions at the time of transplant and three relapsed at 14, 23 and 24 months post transplant.…”

Two Patients Coinfected withMycobacterium lepraeand Human Immunodeficiency Virus Type 1 and Naïve for Antiretroviral Therapy Who Exhibited Type 1 Leprosy Reactions Mimicking the Immune Reconstitution Inflammatory Syndrome

“…However, the association of leprosy with other immunosuppressed conditions is not so evident. There are only scanty reports of leprosy in renal transplant recipients, despite the increasing number of transplants performed in areas where leprosy is highly endemic (16). There have been a number of publications on leprosy and HIV coinfection.…”

Asymptomatic Leprosy Infection among Blood Donors May Predict Disease Development and Suggests a Potential Mode of Transmission

“…There are no reports of M. leprae blood transmission, but there are several reports of leprosy manifestation in individuals after they have undergone organ transplantation (12)(13)(14)(15)(16)(17)(18). However, these studies did not investigate the origin and quality of the blood received by these patients during the surgical procedure nor the origin of the transplanted organs, i.e., whether the donors were from regions where leprosy is endemic.…”