Leprosy Mailing List – March 28th, 2012
Ref.: Clinical case. Borderline leprosy in reaction in a boyFrom: P. Vijayakumaran, Chennai, India
Dear Salvatore,
I refer to the clinical case circulated by via the Leprosy Mailing List – March 24th, 2012. Thank you very much to Dr Barreto and Dr Cabral for sharing the interesting case history (not so interesting for the person affected). I congratulate the team for providing all details for better understanding of the situation and also appropriate management of the condition. I am not a pathologist. Here are my impressions:
· The presentation was atypical so that it could not be related to leprosy.
· Health staff are not aware of presentations of leprosy.
· Leprosy referral hospital may have un-trained staff who cannot identify leprosy.
· Multiple nerve involvement is characteristic of borderline leprosy. That too with in a period of one year goes more in favour.
· Bacteriological Index of 2+ at all sites (probably all selective sites – that means active lesions) may indicate that the disease has progressed beyond borderline tuberculoid leprosy (towards lepromatous leprosy).
· Biopsy - 3+ positive and presence of globi are indicative of lepromatous side of leprosy spectrum.
· Biopsy – Globi and macrophages are characteristics of lepromatous side of the spectrum.
Fig.1 & 2 : Any trained eye will suspect leprosy.
Fig.3 & 4 : Misleading presentation because of scaling and central healing.
Fig.5, 6 & 7 : Trained eyes should be able to suspect leprosy.
Fig.8 : Explains importance of examination of peripheral nerves. Again trained eyes and hands comes to my mind.
Fig.15 & 16 : Clearly clinical presentation of BB leprosy.
This child is fortunate to have intact nerve function. This also warrants close observation for possibility of fresh episodes of reactions and especially neuritis.
I once again thank the authors and the LML for sharing their experience.
With best wishes,
Dr.P.Vijayakumaran,
Regional Medical Coordinator South,
German Leprosy and TB Relief Association India,
#4, Gajapathi street, Shenoy Nagar,
Chennai – 600030, India
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