(Last Updated On: October 29, 2018)

Authors: Michaela M. Tabalon, Claribel L. Jimenez

Abstract

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae primarily affecting the skin, mucous membranes and peripheral nerves. Pregnancy causes a relative decrease in cellular immunity resulting in first appearance of the disease, reactivation, or relapse in treated patients. Alteration in cell mediated and humoral immunity may trigger leprosy reactions. We report a case of a primigravid in her second trimester of pregnancy diagnosed with lepromatous leprosy in type 2 reaction treated with multidrug regimen and prednisone.

Case Summary: A 20-year old primigravid on her 20th week age of gestation presented with erythematous plaques over the extremities associated with numbness, and sudden appearance of multiple erythematous tender nodules over the face and extremities. This was associated with intermittent, undocumented fever and arthralgia. Laboratory examinations revealed anemia, leukocytosis with neutrophilic predominance, and a normal G6PD assay. Slit skin smear was positive. Skin punch biopsy revealed a focally atrophic epidermis with superficial and deep collections of inflammatory infiltrates extending to the subcutaneous layer composed of lymphocytes, histiocytes, foamy macrophages, and rare neutrophils. Diagnosis was Hansen’s Disease, BL-LL, in type 2 reaction. Patient was started on multidrug treatment and prednisone. The patient delivered to a healthy baby boy without perinatal complications.

Conclusion: Leprosy is exacerbated during pregnancy and timely diagnosis and management may prevent potential serious maternal and fetal outcomes. Multidrug therapy consisting of dapsone, rifampicin, and clofazimine is highly effective against leprosy and is considered safe for the mother and the child, and therefore, should be continued during pregnancy.

 

Citation

 

Keywords

dermatology, leprosy, pregnancy, treatment

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