Multiple ulcerative leprosy with delayed diagnosis in a non-endemic region

Extract

Dear Editor,

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that demonstrates higher incidence rates in economically underdeveloped regions. However, with progressively declining incidence rates, leprosy appears to be increasingly neglected.¹ Infection with M. leprae induces cutaneous, mucosal and peripheral nerve damage, although variations in host immune responses lead to distinct clinical manifestations.² Delayed diagnosis and non-standard therapeutic approaches contribute to extensive clinical manifestations, including physical disabilities and deformities, while exacerbating socio-economic burdens, thereby perpetuating leprosy as a critical public health challenge.³

We report a case of borderline lepromatous (BL) leprosy complicated by type 2 lepra reaction (Lucio phenomenon) in a 27-year-old woman from a non-endemic region of China. The diagnosis, established after 4 y of clinical manifestations, was ultimately confirmed by new-onset ulcers on both lower extremities. The patient reported developing faint erythematous patches on the right cheek without identifiable triggers 4 y prior. Due to the absence of subjective symptoms, no medical attention was sought initially. The progressive expansion of cutaneous involvement occurred over time, accompanied by gradual eyebrow loss and mild hypoesthesia. Subsequent referral to the Rheumatology and Immunology Department of a Chengdu hospital yielded no documented diagnosis or standardized therapeutic protocol; the patient discontinued medication autonomously due to unsatisfactory therapeutic response. Approximately 1 month prior to admission, multiple irregular ecchymotic plaques emerged bilaterally on the lower extremities, with partial lesions evolving into erosive ulcers accompanied by significant pain, persistent hypoesthesia, intermittent arthralgia and night sweats (afebrile). Initial management at a local hospital under the provisional diagnosis of ‘infected ulcers’ included topical antimicrobial therapy for 10 d without clinical improvement. The patient had no underlying disease or family history.