Introduction
Leprosy is a chronic infectious disease that may involve the kidneys through immune-mediated mechanisms, most commonly presenting as amyloidosis or proliferative glomerulonephritis. The clinical coexistence of multibacillary leprosy and mesangioproliferative Immunoglobulin A (IgA) nephropathy (IgAN) is rarely documented. It remains a diagnostic challenge to determine if such cases represent a specific infection-related phenomenon or a coincidental association of two distinct disease processes.
Case Description
We report an 18-year-old male with previously treated multibacillary leprosy who presented with generalized oedema, haematuria, and progressive renal dysfunction. Laboratory evaluation revealed nephrotic-range proteinuria and rising serum creatinine. Renal biopsy demonstrated mesangioproliferative IgAN with segmental sclerosis and fibrocellular crescent formation, alongside moderate tubulointerstitial chronicity. Immunofluorescence demonstrated dominant mesangial IgA and C3 deposition. Despite supportive therapy, corticosteroids, and continuation of multidrug therapy, the patient remained dialysis dependent.
Discussion
While our findings demonstrate biopsy-proven IgAN in the setting of leprosy, this should be interpreted as a rare clinical association. There is significant diagnostic complexity when these two entities occur concurrently in the same patient. Hence, clinicians should maintain a high index of suspicion for secondary renal disease in patients with leprosy who develop proteinuria or renal dysfunction. Early renal biopsy is essential to establish the diagnosis and guide appropriate management. Learning points
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