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A difficult case
Leprosy rash precipitated by immunotherapy for suspected inflammatory neuropathy
  1. Almond Leung1,
  2. Brendan John Arnold2,
  3. Timothy Oliver Hodgson3,
  4. Nicholas John Cutfield1,4
  1. 1 Department of Medicine and Neurology, Southern District Health Board, Dunedin, New Zealand
  2. 2 Department of Medicine, Southern District Health Board, Dunedin, New Zealand
  3. 3 Southern Community Laboratories, Dunedin, New Zealand
  4. 4 University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr Almond Leung, Department of Medicine and Neurology, Southern District Health Board, Dunedin 9016, Otago, New Zealand; almondl163{at}gmail.com

Abstract

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae complex, causing skin and nerve lesions with potential for permanent disability. Leprosy can be overlooked in Western settings, as it is more prevalent in low-income and middle-income countries. We describe a 38-year-old woman with a 4-year history of progressive numbness of the left hand incorrectly diagnosed as multifocal acquired demyelinating sensory and motor neuropathy on the basis of clinical and neurophysiological findings. Treatment with empirical weekly corticosteroid followed by intravenous immunoglobulin resulted in the sudden development of a widespread rash; we then diagnosed borderline lepromatous leprosy on skin biopsy. We postulate that the immune treatments induced a temporary state of immune tolerance followed by a rebound of a T cell-mediated immune response resulting in a type 1 immunological response.

  • LEPROSY
  • PERIPHERAL NEUROPATHOLOGY

Data availability statement

No data are available.

https://doi.org/10.1136/pn-2022-003541

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    Data availability statement

    No data are available.

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    Footnotes

    • Contributors AL, BJA and NJC contributed equally to the writing and editing of the manuscript. TOH provided histological diagnosis and expert review of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Adrian Wills, Nottingham, UK and Aisling Carr, London, UK.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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