Leprosy: a clinical case study

What is it about?

Background: Hansen’s disease, commonly known as leprosy, is an infectious disease caused by Mycobacterium leprae, an acid-fast intracellular bacillus (affecting macrophages and Schwann cells), primarily involving the skin and nerves. It is a rare disease in Portugal, with a higher prevalence in developing countries, where it remains a significant public health issue. Aim: To share the difficulties of establishing the correct diagnosis of Hansen´s disease and to raise awareness of this condition, especially in European countries where clinicians are not familiarised with the disease. Methods/description of the case: The case study presented is of a 65-year-old female who visited the emergency department due to sudden onset of purpuric lesions dispersed across her body, accompanied by fever and generalised oedema. A skin biopsy revealed the presence of multiple thrombi and signs of vasculitis in the adipose tissue lobules along with a neutrophilic infiltrate. Bacilloscopy identified numerous acid-fast bacilli, often arranged in ‘globi’. A diagnosis of multibacillary Hansen’s disease with type II immunological reaction (erythema nodosum leprosum) and a possible Lucio phenomenon was established. Conclusion/implications for clinical practice: The importance of obtaining an accurate diagnosis for proper treatment plan implementation is cardinal. In the process of providing care for this population of patients, it is crucial to address wellbeing and promote quality of life, by providing proper pain management, along with odour and exudate control.

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