A type 1 leprosy reaction in a 50-year-old man

A 50-year-old man was diagnosed with leprosy on pre immigration screening in the Philippines and was prescribed oral dapsone and rifampin. He immigrated to Canada 1 month later and discontinued therapy because of a lack of clinical improvement. During this time, new skin lesions developed and were a...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) 2024-09, Vol.196 (30), p.E1043-E1044
Main Authors: Richard-Greenblatt, Melissa, Stryjewska, Barbara, Kalina, Dale R
Format: Article
Language:English
Subjects:
Care and treatment
Dapsone
Diagnosis
Dosage and administration
Health aspects
Humans
Infectious diseases
Leprostatic Agents - therapeutic use
Leprosy
Leprosy - diagnosis
Male
Medicine
Middle Aged
Patient outcomes
Practice
Public health
Rifampin
Skin
Skin lesions
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Summary:A 50-year-old man was diagnosed with leprosy on pre immigration screening in the Philippines and was prescribed oral dapsone and rifampin. He immigrated to Canada 1 month later and discontinued therapy because of a lack of clinical improvement. During this time, new skin lesions developed and were accompanied by swelling and pain in his hands and feet. The patient was seen in our infectious diseases clinic 4 months later. He had erythematous plaque-like lesions on his head, trunk, and extremities (Figure 1) and normal sensation; the lesions were concerning for a type 1 leprosy reaction (T1R). Skin biopsy showed diffuse histiocytic aggregates, granulomas with sparse lymphocytic infiltrates, and acid-fast bacilli, suggestive of borderline lepromatous disease. We reinitiated antimicrobial therapy with 12 months of oral clofazimine 50 mg daily and 300 mg monthly, dapsone 100 mg daily, and rifampin 600 mg monthly. Given his extremity swelling, we also started prednisone 60 mg daily for the treatment of severe T1R.
ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.240040