Itching as presenting symptom of leprosy and reversal reaction

Leprosy Mailing List, May 1^st, 2009

 

Ref.:   Itching as presenting symptom of leprosy and reversal reaction

From: Gilead L, Jerusalem, Israel

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Dear Dr. Noto,

 

I am surprised at the scarcity of responses regarding the association of itching and leprosy, as a presenting sign or as a sign of reversal reaction. You are probably well aware of the small number of patients being treated in the Israeli Hansen DiseaseCenter (200 registered, 5-10 new cases annually).  Nevertheless, in the last 2-3 years we have had at least two cases who presented with itching as their main complaint.

 

The patients were – a 55 year old male which immigrated from India some 10 years prior to presenting to a dermatology clinic with new (2-3 weeks) itchy plaques on his Lt.>Rt. flanks.  A skin biopsy revealed LL and he was referred to us.  This patient also developed a reversal reaction 1.5 years into his MDT course, which also presented with itchiness in the area of his original plaques. 

 

The second patient was a 21 year old female, which immigrated from Ethiopia some 5-6 years earlier.  She also presented at a dermatology clinic with itchy plaques, this time on the ventral parts of her thighs.  In her case, again, the biopsy results showed LL and she was referred to us.

 

In the two cases I report the histology was typical of LL but the clinical picture was less straight forward.  The patients had only a few plaques, distributed asymmetrically.  Smears were AFB positive both from plaques and from apparently uninvolved skin of knees, elbows and earlobes with a +3 - +5 bacillary index.  

 

I think it safe to say that the first patient was a BL.  The second patient already presented with right hand weakness, toe clawing and significant sensory deficits in both palms and soles and some other areas of her skin in the upper and lower limbs. In her case I think LL is more probable.

 

Both patients described specifically itching and not paresthesias (both speak and understand Hebrew well) and definitely had no other dermatologically apparent condition which could explain their complaints.

 

Following these cases we had a discussion regarding the rarity of this presenting symptom and its absence from the textbooks.  I think it might be much more common than presently acknowledged.

 

All the best,

 

Dr. Leon Gilead

Head of The Israeli Hansen's Disease Center

24 Strauss St. Jerusalem Israel

Department of Dermatology

Hadassah University Hospital

Mobile 972-50-7874309