Lepromatous Leprosy with Type II Lepra Reaction and Jejuno-Jejunal Intussusception Possibly due to Strongyloidiasis and / or Mesenteric Lymphadenopathy Presenting as Acute Abdomen

Strongyloides stercoralis can cause hyper-infection in immunosuppressed patients and can cause death if not treated. It often leads to missed or delayed diagnosis due to its nonspecific symptoms and signs. A 38-year-old male patient, a treated case of lepromatous (LL) Hansen's disease, presented with pain abdomen for four days, associated with vomiting, fever and melaena, and skin rash for three days. The skin rash was suggestive of erythema nodosum leprosum. He had been suffering from joint pains for the past four months, for which he had been using oral prednisolone 60 mg/day for four months. Stool examination showed Strongyloideslarvae and occult blood. The contrast-enhanced computerized tomography of abdomen revealed jejuno-jejunal intussusception and mesenteric lymphadenopathy. Biopsy from duodenal mucosa revealed Strongyloides larvae and ova within the mucosal crypts. Immunosuppression secondary to chronic steroid intake, in this case, is the likely cause of strongyloidiasis hyper-infection. The association of LL and strongyloidiasis is infrequent. In leprosy under steroid therapy, the development of abdominal/pulmonary symptoms should raise a suspicion of stongyloidiasis. There is a need to study the incidence of strongyloidiasis in lepromatous leprosy cases to start blanket anthelminthic treatment as prophylaxis in case incidence is high.