Horiguchi Yuji, Kishi Tatsuro, Ozaki Motoaki, Oka Nobuyuki, Izumi Sinzo
Department of Dermatology, Osaka Red Cross Hospital, 5-30 Fudegasaki-Cho, Tennoji-Ku, Osaka 543-8555, Japan.
Nihon Hansenbyo Gakkai Zasshi. 2003 Aug;72(3):259-62. doi: 10.5025/hansen.72.259.
A 26-year-old Indonesian male living in Japan consulted our hospital with complaint of fever, general malaise and infiltrative erythematous plaques associated with lymph node swelling. Physical examination revealed a sensation disorder in the distal portion of the extremities and hypertrophy of peripheral nerves. Histopathology of the skin lesion showed the multifocal granulomatous inflammation containing many acid-fast bacilli associated with infiltration of foam cells and neutrophils. Under the diagnosis of leprosy (LL type) accompanied by erythema nodosum leprosum, the combined chemotherapy (clofazimine, rifampicin, and diphenyl sulfone) was started. For the leprosy reaction, short-term administration of the systemic steroid was added. The general condition was carried out soon, and the sensation disorder has also been gradually improved. The patient came back to Indonesia after 6 months treatment because of the time limit of visa. We traced the patient's condition through personal networks, and knew that the patient could not have continual treatment for the disease, and that he is suffering from disability of hands and feet. In this case, several medical facilities were consulted before the final diagnosis of leprosy. The Japanese medical doctors should also remember this disease when they examine persons with infiltrative skin eruptions and sensation disorders.
一名居住在日本的26岁印度尼西亚男性因发热、全身不适以及伴有淋巴结肿大的浸润性红斑斑块前来我院就诊。体格检查发现四肢远端感觉障碍及周围神经粗大。皮肤病变的组织病理学检查显示多灶性肉芽肿性炎症,含有许多抗酸杆菌,并伴有泡沫细胞和中性粒细胞浸润。在诊断为伴有麻风结节性红斑的麻风(LL型)后,开始联合化疗(氯法齐明、利福平及二苯砜)。针对麻风反应,加用了短期全身性类固醇治疗。患者一般状况很快好转,感觉障碍也逐渐改善。由于签证期限,患者在治疗6个月后返回印度尼西亚。我们通过个人网络追踪患者病情,得知患者无法继续接受该病治疗,且正遭受手足残疾之苦。在这个病例中,在最终诊断为麻风之前曾咨询过几家医疗机构。日本医生在检查有浸润性皮肤疹和感觉障碍的患者时也应记住这种疾病。