Department of Leprosy, Shanghai Dermatology Hospital, No.1278 Bao De Road, 200443, Shanghai, People's Republic of China.
Department of Therapy, Shanghai Dermatology Hospital, No.1278 Bao De Road, 200443, Shanghai, People's Republic of China.
Infect Dis Poverty. 2018 Jun 17;7(1):58. doi: 10.1186/s40249-018-0441-4.
Type 1 leprosy reaction, also known as "reversal reaction", is related to cellular immune responses to Mycobacterium leprae antigens. The risk factors that trigger type 1 leprosy reactions are poorly understood. Leprosy with concurrent tetanus is rare, and there are no publicly available reports of a leprosy patient infected with tetanus that induced type 1 leprosy reactions.
A 56-year-old Chinese Han female presented to our hospital with symptoms of erythematous plaques and pain over her left upper limb for 2 days and foreign object sensation in her throat for 3 days. The patient had a 6-year history of leprosy. Type 1 leprosy reactions were initially considered, followed by treatment with methylprednisolone. Two days later, the patient's symptoms were aggravated, with neck muscle tension and difficulty in opening her mouth, and the erythematous plaques had spread over most of her left upper limb. After further careful examinations, we confirmed the diagnosis of tetanus with concurrent type 1 leprosy reactions. The patient was given anti-tetanus treatment for 12 days and anti-leprosy reaction treatment for 4 months; the diseases were eventually controlled.
This report suggests that tetanus infection may be a trigger for type 1 leprosy reactions.
1 型麻风反应又称“逆转反应”，与机体对麻风分枝杆菌抗原的细胞免疫反应有关。引发 1 型麻风反应的危险因素尚不清楚。同时患有破伤风的麻风病较为罕见，目前尚无公开报道的麻风病患者感染破伤风后引发 1 型麻风反应的病例。
一名 56 岁汉族女性因左上肢红斑伴疼痛 2 天、咽喉异物感 3 天就诊于我院。患者患有麻风病 6 年，最初考虑 1 型麻风反应，给予甲泼尼龙治疗。2 天后，患者症状加重，出现颈部肌肉紧张，张口困难，红斑已扩散至左上肢大部分区域。进一步详细检查后，我们确诊为同时患有破伤风的 1 型麻风反应。患者接受了 12 天的破伤风治疗和 4 个月的抗麻风反应治疗；最终疾病得到了控制。
本报告提示破伤风感染可能是引发 1 型麻风反应的一个诱因。
