Schneider Joanna, Mays Rhett
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Mission Hospital, Asheville, NC, USA.
Case Rep Infect Dis. 2018 Aug 14;2018:6125215. doi: 10.1155/2018/6125215. eCollection 2018.
Leprosy, or Hansen's disease, is caused by infection with . It is a rare diagnosis within the continental United States. We present the case of a 13-year-old immigrant from the Marshall Islands who presented with recurrent nausea, vomiting, and abdominal pain which are found to be due to intermittent gastric volvulus. Gastric volvulus is also exceedingly rare, with less than 8 pediatric cases on average per year. During her second hospitalization for recurrent acute gastrointestinal issues, nonspecific skin lesions were biopsied, revealing infection with . The patient did not exhibit classic symptoms of leprosy but did have prominent skin changes including diffuse nodules. This case explores the pathophysiology connecting leprosy to volvulus, discussing the possible role of an inflammatory response to infection in causing gastric volvulus. The finding of lepromatous leprosy may have been unrelated but was fortuitous, as early intervention will result in avoidance of debilitating peripheral neuropathy and eventual disfiguration from Hansen's disease. This case highlights the importance of considering rare causes of gastric outlet obstruction including gastric volvulus and of considering leprosy in the differential for patients with unusual skin lesions or paresthesias who have a history of living or traveling in endemic areas.
麻风病，即汉森氏病，是由感染……引起的。在美国大陆，这是一种罕见的诊断病例。我们报告了一例来自马绍尔群岛的13岁移民病例，该患者反复出现恶心、呕吐和腹痛，经检查发现是由间歇性胃扭转所致。胃扭转同样极为罕见，平均每年儿科病例少于8例。在她因反复出现急性胃肠道问题而第二次住院期间，对非特异性皮肤病变进行了活检，结果显示感染了……。该患者未表现出麻风病的典型症状，但确实有明显的皮肤变化，包括弥漫性结节。本病例探讨了将麻风病与胃扭转联系起来的病理生理学，讨论了感染引发的炎症反应在导致胃扭转中可能起到的作用。瘤型麻风的发现可能并无关联，但很偶然，因为早期干预将避免汉森氏病导致的使人衰弱的周围神经病变以及最终的毁容。本病例强调了考虑胃出口梗阻的罕见病因（包括胃扭转）的重要性，以及对于有不寻常皮肤病变或感觉异常且有在流行地区生活或旅行史的患者，在鉴别诊断中考虑麻风病的重要性。
