Lepromatous leprosy: Case based clinico-histologic discussion

Introduction: Leprosy is endemic in some developing nations and accordingly, remains an important public health concern. Although leprosy has even been reported in isolated cases in developed countries, including Australia, little is published about its diagnosis and treatment in such settings1.
Case: A 29-year-old man originally from Sri Lanka living in Australia was referred by his GP for a 12-month history of 2 non-healing ulcers on his right lower limb, and 6-month history of progressive papular eruption affecting his entire body including face, hands and feet.
Discussion: Several forms of leprosy have been described, which are classified according to clinical features. Each clinical type also correlates with a distinct histological pattern. Case reports have highlighted delays in diagnosis of leprosy in the developed world due to a lack of clinician knowledge about the condition in such settings. The cases of leprosy in Australia, although infrequent, emphasise the importance of considering leprosy in the differential diagnosis in Indigenous Australians and patients from endemic countries who present with skin changes and/or neuropathy, even if exposure was like to be year’s ago2.
Conclusion: Despite the infrequent incidence of leprosy in developed nations, doctors should be well aware of the signs and symptoms of leprosy and ensure a biopsy or urgent referral to a specialist be performed for further evaluation. Early detection and management is key to control and minimise associated long-term disability.
1. Barkla S, Modi S. Lepromatous leprosy: A rare presentation in Australia. The Australasian Medical Journall. 2013[cited 6(4):175-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650307/
2. Pardillo FEF, Fajardo TT, Abalos RM, Scollard D, Gelber RH. Methods for the Classification of Leprosy for Treatment Purposes. Clinical Infectious Diseasesl. 2007[cited 44(8):1096-9. http://cid.oxfordjournals.org/content/44/8/1096.abstract

Dr. Emily Shao