Diagnosing lepromatous leprosy by liver biopsy: A case of granulomatous hepatitis

Hansen’s disease (HD) is a chronic and contagious disease caused by Mycobacterium leprae. After the neurocutaneous system and the lymph nodes, the liver is the organ most commonly affected, secondary to hematogenous dissemination of the bacilli to the liver, immune-mediated inflammatory infiltrate in reactional states or due amyloid deposits may also be detected in the liver. The authors report on a patient with lepromatous HD whose initial symptoms and diagnosis relied in the presence of granulomatous hepatitis by liver biopsy. Although liver involvement in leprosy is more frequent than suspected, clinical manifestations resulting from its damage are uncommon. Therefore, when treating a patient with multibacillary HD, physicians should be aware that this is a multisystemic disease and that multiple organs may be affected. Furthermore this case also shows that the slow skin infiltration in lepromatous HD may be associated with lack of clinical diagnosis and favor a severe compromise in internal organs.