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01.12.2019 | Case report | Ausgabe 1/2019 Open Access

Journal of Medical Case Reports 1/2019

Leprosy – eliminated and forgotten: a case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2019
Autoren:
Shiva Raj K.C., Geetika K.C., Purnima Gyawali, Manisha Singh, Milesh Jung Sijapati
Wichtige Hinweise

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Abstract

Background

Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual.

Case presentation

In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication.

Conclusion

An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

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