Clinical case

Leprosy Mailing List,
June 22nd, 2009
Ref.: Clinical case
From: Ariyawansa D., Thalapathpitiya, Nugegoda, Sri Lanka

Dear Dr Noto,

I would like to present a case to LML members for their opinion.

18 year old female was treated for a single patch, histologically proven tuberculoid leprosy, with paucibacillary treatment according to WHO guidelines (Rifampicin-monthly, Dapsone-daily).

Pre Treatment Full blood count, Liver funtions and G6PD levels were normal. Presented with high remittent fever (101-103 F) and jaundice 3weeks after commencement of anti-leprosy treatment with evidence of deep jaundice and hepato-splenomegaly on examination.

Investigations
*WBC/DC(10x 3 / UL) Total 5.3---8.3--8.6---13.5---16.8---19.07---27
(with Neutrophil leucocytosis and mild eosinophilia)

Haemoglobin (g/dl)- 8.37--8.9---7.7--8.1----8.6.

Platelet count-with in normal range
Retic count-5%---10%
ESR (mm/1st hour) 20--40--32
Blood Picture-suggests intra vascular Hemolysis with a left shift (?underling infective origin)
S. Bilirubin(mg/dl) Total 8.1 10.6 16.6 19.2
Direct 6.9 8.6 14.2 15.8
Indirect 1.2 1.8 2.4 3.4
Serum Alkaline Phosphatase (U/L)-395 587 761
SGOT- 472 370 551 266
SGPT- 419 401 545 442
Hepatitis Screening ( A,B,C)- Negative
Urine for Hemosiderin-Negative
CRP- 12 mg/dl
Mycoplasma AB-Negative
S. Creatinine 31 Mmol/L
Urine full report-Few granular casts Monospot test-Negative Widal Test-Negative

APTT and Thrombin Test-with in normal range USS abdomen-Hepato-splenomegaly with thickened wall of Gall bladder, no evidence of Gall bladder calculi or liver abscesses.

Management Discontinued anti Leprosy treatment Broad Spectrum antibiotics Monitor vital parameters
Still being managed as a inward patient

My question is:- Can we explain this picture with Anti Leprosy drugs alone or is it a double pathology?

Thanking you,

Dr Dananja Ariyawansa
Sri Jayawardenepura General Hospital
Thalapathpitiya Nugegoda Sri Lanka