Itching in leprosy

Leprosy Mailing List, April 30^th, 2009

 

Ref.:   Itching in leprosy

From: Manimozhi N., Bangalore , India

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Dear Dr. Salvatore Noto,

This is with reference to Dr Pai’s Leprosy Mailing List, April 25th, 2009, Pruritus in BL, LL and smear positive relapse leprosy lesions.

During my tenure at SLR&TC – Department of Epidemiology and leprosy control from 1985 through 2001, we had come across instances where patients reported with pruritus as the main complaint and diagnosis of reactions and relapse was made after examination.  It was noted that it was actually – parasthesia (abnormal sensation) which the patients expressed it to as itching (pruritus) in their own local language and some did mention as burning sensation as well.

Brief case study: Mono- therapy Relapse case presenting with pruritus/rashes as main complaint.

An elderly Anglo-Indian (Mr. Hawkinns – name changed) inmate of Cheshire Home at Virudampet /Vellore, Tamil Nadu, India aged more than 70 years, a know case of Lepromatous leprosy released from treatment. He had an interesting history of treatment started with Hydnocarpus oil injections and Dapsone.  He used to attend the outreach village clinics conducted within the Cheshire Home campus for general complaints along with others.  All the inmates had a separate released from control (RFC) register maintained in which all clinical, treatment details where documented.

It was around 1992 to 1995, there was an anniversary celebrations of Cheshire at UK for which Mr. Hawkinns was invited to attend the function.  The British Airways wanted a certification of fitness and not infectious to others from a specialized institution.  He was very carefully screened by 2 senior specialist and me as well, skin smear examination carried out which was negative and he was declared to be sign free.  Mr. Hawkinns visitedUK , and he could meet all his cousins there spent about more than a month and returned back.  And during our clinic day at the Cheshire Home centre he attended the clinic looking very cheerful, happy but with some complaints of rashes associated with itching, while on examination few micro-papular lesions and plaques where noticed and a skin smear examination was carried out and was positive with BI more than 2+, which ultimately turned out to be a relapse.  Multi-drug therapy MB was initiated and after few months our good friend passed away due to some other general illness.  I am sure Mr. Hawkinns case card is well preserved in the records department (deleted as Expired) to verify in case accurate and or more details is needed.

Lesson learnt from this episode is :

Leprosy is indeed a great imitator.

Presentation of complaints in patients own terminology may be misleading.

Routine sites can show skin smear negativity – While lesions in relapse cases can occur in rare sites which could show skin smear positivity.

It may take a short duration of time (2-3 months in this case) for the disease to express signs of relapse after the last clinical/bacteriological examination.

Dr. N. Manimozhi

Medical Coordination- AIFO

Bangalore, India