Hansen’s disease patient in Ohio successfully treated with a monthly rifampin, minocycline, and moxifloxacin regimen: a case report

Background Hansen’s disease, also known as leprosy, is an infection of the skin and peripheral nerves that is rarely encountered in the United States. This case describes a patient without recent international travel who achieved a successful therapeutic outcome using a new monthly multidrug treatment regimen recommended by the National Hansen’s Disease Program.

Case Summary A 78-year-old male presented with peripheral neuropathy, widespread macular erythematous rash involving face, trunk, extremities, bilateral hand edema, and oligoarticular unilateral elbow and knee bursitis. A skin biopsy revealed a lymphohistiocytic infiltrate in the presence of acid-fast bacilli (AFB) without globi. No AFB were recovered from tissue culture. Direct molecular testing from the skin biopsy detected Mycobacterium leprae . The patient had no recent risk factors for contracting Hansen’s disease, other than travel to Florida. The patient was treated with a monthly multidrug therapy regimen of rifampin, moxifloxacin, and minocycline (RMM) and had successful clinical reduction in disease manifestations.

Conclusion Hansen’s disease is uncommon in the United States, especially in the Midwest. However, providers should include Hansen’s disease on their differential even if recent travel was only domestic, particularly to Florida. In addition, the monthly multidrug treatment regimen RMM is an effective monthly treatment alternative, especially for patients with concerns of intolerance to first-line drugs.