Departments of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia.
Department of Radiology, Charles Nicolle Hospital, Tunis, Tunisia.
Int J Dermatol. 2011 Nov;50(11):1383-1386. doi: 10.1111/j.1365-4632.2011.04935.x.
To remind special attention to atypical symptoms of Hansen's disease, we report a case of an atypical case due to a delayed diagnosis.
Clinical features of leprosy are well known, cutaneous lesions and involvement of the peripheral nerves being the cardinal clinical signs. Among these presentations, systemic involvement, including mucous membranes of the upper respiratory tract and eyes, is rarely reported even if it is still commonly seen in endemic areas, in particular lepromatous leprosy.
We describe here a new case of Hansen's disease in a 51-year-old Tunisian woman with an atypical presentation and a delayed diagnosis. The early symptoms of the disease were different from the main clinical signs of Hansen's disease since they involved the upper respiratory tract and the eyes. A nasal smear was positive for acid-fast bacilli, thus confirming the diagnosis of bacilliferous leprosy. Histological findings suggested the diagnosis of leprosy and were somewhat more characteristic of the borderline lepromatous type.
Diagnosis of Hansen's disease in patients with neither apparent skin lesions nor neurological signs is still problematic. Clinicians should not only pay attention to the more obvious signs in their own fields of expertise but should be aware of the possible systemic involvement of leprosy.
提醒特别注意麻风病的非典型症状，我们报告了一例因诊断延迟而导致的不典型病例。
麻风病的临床特征众所周知，皮肤损伤和周围神经受累是主要的临床体征。在这些表现中，包括上呼吸道和眼睛在内的全身受累虽然在流行地区仍很常见，但很少有报道，特别是麻风瘤型麻风病。
我们在这里描述了一例 51 岁突尼斯妇女的麻风病新病例，其表现不典型且诊断延迟。疾病的早期症状与麻风病的主要临床特征不同，因为它们涉及上呼吸道和眼睛。鼻涂片抗酸杆菌阳性，从而确诊为杆菌性麻风病。组织学发现提示麻风病的诊断，且更具边界瘤型麻风病的特征。
对于既无明显皮肤损伤也无神经体征的麻风病患者，其诊断仍存在问题。临床医生不仅应注意自身专业领域中更明显的体征，还应意识到麻风病可能存在全身受累。
