02099nas a2200277   4500000000100000008004100001260001300042653000900055653002600064653001100090653002500101653001600126653001600142653000900158653002500167653000900192653003000201100001100231700001500242700001200257245005700269300001100326490000600337520146400343022001401807       2003                            d  c2003 Dec10aAged10aHeart Transplantation10aHumans10aLeprosy, lepromatous10aLymphocytes10aMacrophages10aMale10aMycobacterium leprae10aSkin10aSkin Diseases, Infectious1 aModi K1 aMancini MC1 aJoyce P00aLepromatous leprosy in a heart transplant recipient.  a1600-30 v33 a<p>Northern Louisiana is not an area for indigenous cases of leprosy. Limited data are available on the occurrence of leprosy in organ transplant recipients. No cases have been reported in heart transplant recipients. Mr J.R. is a 68-year-old man from Shreveport, Louisiana. He underwent orthotopic heart transplantation in March 1996. He presented in March 2000 with a maculopapular skin rash and intermittent hand swelling for 5 months. He also complained of intermittent burning of his feet for a year. The skin lesions were of two types - a fine red migratory, intermittent maculopapular rash over the upper torso and a raised, larger, violaceaous lesion on his hands. Neurological examination revealed complete loss of protective sensation in the right foot by filamentous test and some loss in the left foot. Punch skin biopsies from his right arm and right chest lesion revealed abundant acid-fast bacilli (AFB). Histopathologic examination revealed perivascular, interstitial and perineural granulomatous inflammation and a large number of AFB organisms within histiocytes. Culture of the skin biopsy specimen was negative for Mycobacterium tuberculosis or atypical mycobacterium. Polymerase chain reaction (PCR) performed for Mycobacterium leprae was positive. The patient was treated with a modified regimen consisting of dapsone 100 mg qd, ethionamide 250 mg qd, and minocycline 100 mg qd. His skin rash and neurological symptoms have resolved.</p>  a1600-6135