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Leprosy - eliminated and forgotten: a case report.

Abstract

BACKGROUND: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual.

CASE PRESENTATION: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still's disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication.

CONCLUSION: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

More information

Type
Journal Article
Author
Shiva Raj K C
Geetika K
Gyawali P
Singh M
Sijapati MJ
Year of Publication
2019
Journal
Journal of medical case reports
Volume
13
Issue
1
Number of Pages
276
Language
eng
ISSN Number
1752-1947
DOI
10.1186/s13256-019-2198-1
Alternate Journal
J Med Case Rep
Publication Language
eng