Kumari Sandhya, Verma Ghanshyam K, Negi Ajeet K, Sharma Aakanksha
Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Indian Dermatol Online J. 2023 Nov 24;15(3):500-503. doi: 10.4103/idoj.idoj_294_23. eCollection 2024 May-Jun.
Leprosy is a silent disease with protean manifestations, especially during lepra reactions (LRs). Cases with atypical leprosy or LR simulate a number of conditions misdiagnosed frequently. Here, three classical cases of leprosy are reported for their complex presentation. Leprosy was hidden in Case 1 due to co-existing diabetes. COVID vaccination induced LR unmasked all leprosy lesions, which were extensive, large, bizarre and spreading to various immune zones. Case 2 presented with high-grade fever, tachycardia, generalized erythema and body aches. A detailed workup unveiled his leprosy with a rare presentation of Type 1 lepra reaction (T1LR) with erythroderma and severe systemic symptoms. Case 3 mimicked sarcoidosis and lupus erythematosus (LE) on routine workup. She had facial lesions in the malar area, photosensitivity, joint pains, raised angiotensin-converting enzyme (ACE) levels and positive anti-nuclear antibodies. Peri-appendageal granulomas on histopathology and therapeutic response to multidrug therapy helped in the early diagnosis of leprosy.
麻风是一种具有多种表现形式的隐匿性疾病，尤其是在麻风反应（LRs）期间。非典型麻风或LR的病例常被误诊为多种病症。在此，报告三例经典的麻风病例，因其临床表现复杂。病例1因合并糖尿病而隐匿了麻风病情。新冠疫苗接种引发的LR使所有麻风病灶显现出来，病灶广泛、巨大、形态怪异且扩散至各个免疫区域。病例2表现为高热、心动过速、全身性红斑和身体疼痛。详细检查揭示其患有麻风，伴有罕见的1型麻风反应（T1LR），出现红皮病和严重的全身症状。病例3在常规检查中被误诊为结节病和红斑狼疮（LE）。她面颊部有皮损、光敏、关节疼痛、血管紧张素转换酶（ACE）水平升高以及抗核抗体阳性。组织病理学检查发现附属器周围肉芽肿以及对多药联合治疗的反应有助于早期诊断麻风。
