Recurrent lepromatous leprosy in 68-year-old female

Leprosy is chronic disease by Mycobacterium leprae (M. leprae). M. leprae is gram-positive, intracellular, aerobic, acid-fast, rod-shaped virus well grows on 27-30 ℃ often found in tropical countries. There are five types; tuberculoid, borderline tuberculoid, borderline, borderline lepromatous and lepromatous leprosy. Borderline leprosy is most common and lepromatous leprosy shows symmetric nodules, plaques, thickened dermis, and frequently involves nasal mucosa resulting in nasal congestion and epistaxis, but, typically, detectable nerve damage is late. The prevalence and incidence rates in Korea were declined by active governmental management and multiple anti-leprosy agents. 68-year-old female presented with erythematous nodules on her forehead, both cheeks, and nose lasting for two year. Before visiting our department, she was erroneously treated with oral and topical steroid as granuloma faciale but had not been improved. In the interview, there was no specific past medical history. But, after diagnosis as lepromatous leprosy, we checked Korean Hansen Welfare Assocation (KHWA) and she has a past medical history of leprosy in 1968 which is treated with dapsone. We performed skin smear test, punch-biopsy with AFB stain from the nodule on her face and PCR for leprae DNA. Patient was diagnosed with recurred lepromstous leprosy. She was transferred to KHWA and treated with multi-drug treatment (dapsone, rifampicin, clofazimine).