02216nas a2200217   4500000000100000008004100001260004600042653003900088653001200127653002000139100001700159700001800176700001600194700001300210245009200223856013300315300001200448490000600460520150700466022002501973       2025                            d  bOvid Technologies (Wolters Kluwer Health)10aHemophagocytic lymphohistiocytosis10aLeprosy10aType 2 reaction1 aMadegowda SB1 aKakrannaya MP1 aKalegowda D1 aNaidu HM00aHemophagocytic Lymphohistiocytosis in Leprosy: A Rare and Life-threatening Complication  uhttps://journals.lww.com/cddr/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=ArticleViewer&an=02006588-202510000-00013  a372-3740 v93 a<jats:p>Leprosy, a chronic mycobacterial disease, is caused by the acid-fast bacillus <jats:italic toggle="yes">Mycobacterium leprae</jats:italic>. The clinical manifestations of this disease depend on the host’s immunity against <jats:italic toggle="yes">M. leprae</jats:italic>. Hemophagocytic lymphohistiocytosis (HLH) is a rare complication that has been reported in association with leprosy. The acquired form of HLH is mainly caused by infections (including various viruses, bacteria, fungi, and parasites), drugs, malignancies, and autoimmune diseases. <jats:italic toggle="yes">Mycobacterium</jats:italic>-triggered HLH has been reported in recent times; however, very few cases have been associated with leprosy. HLH is a rapidly fatal condition with a mortality rate in adults exceeding 50%. Unless an early diagnosis is made and prompt intervention with high-dose steroids and immunoglobulins is undertaken, the mortality rate remains high. Furthermore, the clinical presentation of HLH often coincides with primary sepsis, leading to the withholding of immunosuppressants, which further aggravates the condition. Early diagnosis and prompt intervention in this rare condition are essential to prevent mortality. We describe a case of lepromatous leprosy in a type II reaction on multibacillary-multi-drug therapy treatment, with an unusual, complicated course, characterized by unexplained persistent fever, organomegaly, bicytopenia, and elevated levels of inflammatory markers.</jats:p>  a2542-551X, 2542-5528