Yerke Hansen Payton, Myers Elisha, Rajalingam Karan, Labanowski Mary
Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Cureus. 2023 Aug 1;15(8):e42816. doi: 10.7759/cureus.42816. eCollection 2023 Aug.
We present the case of a 37-year-old Haitian male who presented with a seven-month history of skin lesions on his face and extremities, weight loss, intermittent chills, difficulty in breathing, and bilateral paresthesias in his feet. The lesions were most prominent on the pinnae of the ears. Biopsy of the lesions revealed large, rounded granulomatous infiltrates and histiocytes. Acid fast (Ziehl-Neelsen technique) and Kinyoun stains were positive for numerous acid-fast mycobacteria within the histiocytes. A polymerase chain reaction (PCR) was positive for which confirmed a diagnosis of lepromatous leprosy. Further analysis revealed positive purified protein derivatives (PPD) and QuantiFERON-TB™ test (QIAGEN, Hilden, Germany) with negative chest x-ray and sputum cultures. Labs also revealed vitamin D and G6PD (glucose-6-phosphate-dehydrogenasedeficiency. The patient was started on a combined therapy regimen of rifampin, moxifloxacin, and minocycline. In addition, he was started on vitamin D supplementation. After undergoing treatment for one year, there was notable regression of the patient's cutaneous lesions. Treatment is planned to continue for a total of 24 months. This case exemplifies the successful treatment of Hansen's disease in a patient with a G6PD deficiency. The patient's G6PD deficiency required avoidance of dapsone, which is typically used in the treatment of Hansen's disease. Furthermore, the patient's positive PPD and QuantiFERON-TB tests led to a delay in the treatment in order to rule out active tuberculosis. Left untreated, Hansen's disease has a high morbidity risk. Treatment regimens require careful consideration of coexisting comorbidities.
我们报告了一例37岁的海地男性病例，该患者面部和四肢出现皮肤病变达7个月之久，伴有体重减轻、间歇性寒战、呼吸困难以及双脚双侧感觉异常。病变在耳廓处最为明显。病变活检显示有大量圆形肉芽肿浸润和组织细胞。抗酸染色（萋-尼氏技术）和金胺染色显示组织细胞内有大量抗酸分枝杆菌呈阳性。聚合酶链反应（PCR）检测呈阳性，确诊为瘤型麻风。进一步分析显示纯化蛋白衍生物（PPD）试验和全血γ干扰素释放试验（QuantiFERON-TB™ test，德国希尔德QIAGEN公司产品）呈阳性，胸部X光检查和痰培养呈阴性。实验室检查还发现维生素D缺乏和葡萄糖-6-磷酸脱氢酶（G6PD）缺乏。患者开始接受利福平、莫西沙星和米诺环素联合治疗方案。此外，开始补充维生素D。经过一年的治疗，患者的皮肤病变明显消退。计划总共持续治疗24个月。该病例例证了成功治疗一名患有G6PD缺乏症的汉森病患者。患者的G6PD缺乏症需要避免使用通常用于治疗汉森病的氨苯砜。此外，患者PPD试验和全血γ干扰素释放试验呈阳性，导致治疗延迟以排除活动性结核病。若不治疗，汉森病有很高的发病风险。治疗方案需要仔细考虑并存的合并症。
