Sami Chowdhury Adnan, Hassan Shadman Shabab, Khan Abed Hussain, Hasan Md Nazmul, Arafat Shohael Mahmud
Department of Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
Cureus. 2022 Apr 6;14(4):e23892. doi: 10.7759/cureus.23892. eCollection 2022 Apr.
In Bangladesh, tuberculosis and leprosy are endemic mycobacterial diseases; however, co-infection is rarely seen. Our patient had a high-grade fever, symmetrical polyarthritis, polymorphous erythematous lesions, widespread lymphadenopathy, peripheral neuropathy, bilaterally thickened ulnar nerves, and claw hands. A lymph node biopsy revealed tuberculosis having acid-fast bacilli with caseating epithelioid histiocytic granuloma. Cutaneous lesions and sural nerve biopsies indicated borderline lepromatous leprosy. Fite-Faraco stain showed the presence of lepra bacilli in the biopsied sural nerve. Mantoux test showed 15 mm induration in 72 hours. Nerve conduction study (NCS) showed severe sensory-motor polyneuropathy (axonal) of all four limbs. Prednisolone and thalidomide for severe type-2 lepra response and category-01 antituberculosis medication and multidrug therapy for multibacillary leprosy improved the patient's condition. Bacille Calmette-Guérin (BCG) vaccination in the community might protect against tuberculosis and leprosy, thus reducing such coinfection. However, reduced cell-mediated immunity might promote latent tuberculosis reactivation or super-infection in individuals with multi-bacilli illnesses.
在孟加拉国，结核病和麻风病是地方性分枝杆菌病；然而，合并感染很少见。我们的患者有高热、对称性多关节炎、多形性红斑病变、广泛的淋巴结病、周围神经病变、双侧尺神经增粗以及爪形手。淋巴结活检显示结核有抗酸杆菌及干酪样上皮样组织细胞肉芽肿。皮肤病变和腓肠神经活检提示为界线类偏瘤型麻风。Fite-Faraco染色显示活检的腓肠神经中有麻风杆菌。结核菌素试验显示72小时硬结为15毫米。神经传导研究（NCS）显示四肢均有严重的感觉运动性多发性神经病（轴索性）。泼尼松龙和沙利度胺用于重度2型麻风反应，01类抗结核药物和多药联合疗法用于多菌型麻风，改善了患者的病情。社区中的卡介苗接种可能预防结核病和麻风病，从而减少此类合并感染。然而，细胞介导免疫的降低可能会促进潜伏性结核的重新激活或在患有多菌型疾病的个体中发生重复感染。
