Leprosy in Pregnancy: A Case Series in 4 Dermatology Clinics in Malaysia

Introduction
Management of leprosy in pregnancy is challenging. Here we aim to describe the clinical characteristics and the management of leprosy in pregnancy.

Methods
This is a retrospective study on pregnant women with leprosy managed in the Department of Dermatology in Hospital Kuala Lumpur, Hospital Pulau Pinang, Hospital Sultanah Bahiyah and Hospital Queen Elizabeth between 1994 and 2015.

Results
There were ten patients with 12 pregnancies with a median age of 27.5 years (range: 16-33). Five were foreigners. There were four cases of lepromatous leprosy, two cases of borderline lepromatous, two cases borderline tuberculoid leprosy and one case each for tuberculoid and mid borderline leprosy. Seven pregnancies (58%) were documented to have reactions. Four reversal reactions (33%), three erythema nodusom leprosum (25%) and two Lucio’s phenomenon (17%) were documented. Both patients with Lucio’s phenomenon had undiagnosed leprosy and presented with preterm labour, anemia, oligohydramnios and intrauterine growth restriction. Mortality was recorded in one patient due to dapsone induced hypersensitivity syndrome complicated with septicaemia. All patients were prescribed multidrug therapy but in three pregnancies, the patients chose to defer the treatment. There was a spontaneous miscarriage at second trimester and a case of early neonatal death. The neonatal complications recorded for the 10 live deliveries were low birth weight, jaundice and clofazimineinduced hyperpigmentation.

Conclusion
The majority of our patients with leprosy had complications throughout the pregnancies. Early detection and prompt treatment can prevent unfavorable fetal outcome & threatened maternal health.