Alnimr Amani M, Alsharari Mohammad A, Alabkari Fatemah M, Alsalem Fatemah A, AlShehail Bashayer M, Alhajri Mashael, AlKhaleefah Qasim S, Alwazzeh Marwan J
Department of Microbiology, King Fahad Hospital of the University and College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad hospital of the University, Al-Khobar, Saudi Arabia.
Infez Med. 2024 Dec 1;32(4):538-543. doi: 10.53854/liim-3204-13. eCollection 2024.
Leprosy, a chronic infectious disease caused by complex, remains a significant global health concern despite being curable with multidrug therapy. Delayed diagnosis is common, particularly in non-endemic regions or when presenting with atypical symptoms. This can lead to missed opportunities for early intervention, potential disabilities, and increased transmission. Misdiagnosis is often compounded by leprosy's ability to mimic other conditions, as illustrated in this case report. We present a 43-year-old Filipino woman residing in Eastern Saudi Arabia, who presented to a dermatology clinic with a four-year history of recurrent skin rashes and a one-year history of painful, itchy nodules on her shins. She denied any systemic symptoms, recent travel, or known tuberculosis (TB) contact. Physical examination revealed multiple erythematous nodules on her shins with hyperpigmentation, but no lymphadenopathy or other skin lesions. Initial laboratory tests, including blood counts, liver and kidney function, inflammatory markers, and HIV screening, were normal. Chest X-ray was unremarkable. The patient's clinical presentation and laboratory results led to a provisional diagnosis of extrapulmonary TB, and she was started on anti-TB treatment. However, her condition did not improve after several months of treatment. A skin biopsy was performed, and histopathological examination revealed granulomatous inflammation with acid-fast bacilli, raising suspicion for leprosy. Subsequent culture of the skin biopsy unexpectedly yielded , confirming the diagnosis of lepromatous leprosy. The case study highlights the diagnostic challenges associated with leprosy, especially in non-endemic regions. The patient's atypical presentation, lack of systemic symptoms, and the unexpected growth of in cell-free culture media contributed to the initial misdiagnosis and delayed treatment. Early suspicion, prompt skin biopsy, and appropriate culture techniques are crucial for accurate diagnosis and timely initiation of effective therapy to prevent disability and transmission. This case also underscores the importance of considering leprosy as a differential diagnosis in patients presenting with atypical skin lesions, even in non-endemic areas. Continued awareness and education among healthcare providers are essential to improve early recognition and management of this treatable disease.
麻风病是一种由麻风分枝杆菌引起的慢性传染病，尽管通过多药联合治疗可以治愈，但它仍然是一个重大的全球健康问题。延迟诊断很常见，尤其是在非流行地区或出现非典型症状时。这可能导致错过早期干预的机会、潜在的残疾以及传播增加。麻风病能够模仿其他病症，这常常使误诊情况更加复杂，本病例报告就说明了这一点。我们介绍一位居住在沙特阿拉伯东部的43岁菲律宾女性，她前往皮肤科诊所就诊，有四年反复出现皮疹的病史，以及一年来小腿出现疼痛、瘙痒结节的病史。她否认有任何全身症状、近期旅行史或已知的结核病接触史。体格检查发现她的小腿有多个伴有色素沉着的红斑结节，但没有淋巴结肿大或其他皮肤病变。最初的实验室检查，包括血常规、肝肾功能、炎症标志物和艾滋病毒筛查，结果均正常。胸部X光检查无异常。患者的临床表现和实验室检查结果导致初步诊断为肺外结核，于是她开始接受抗结核治疗。然而，经过几个月的治疗，她的病情并未改善。进行了皮肤活检，组织病理学检查显示有肉芽肿性炎症并伴有抗酸杆菌，这引起了对麻风病的怀疑。随后对皮肤活检样本进行培养，意外地培养出了麻风分枝杆菌，从而确诊为瘤型麻风。该病例研究突出了与麻风病相关的诊断挑战，特别是在非流行地区。患者的非典型表现、缺乏全身症状以及在无细胞培养基中意外培养出麻风分枝杆菌，导致了最初的误诊和治疗延迟。早期怀疑、及时进行皮肤活检以及采用适当的培养技术对于准确诊断和及时开始有效治疗以预防残疾和传播至关重要。这个病例还强调了即使在非流行地区，对于出现非典型皮肤病变的患者，也应将麻风病作为鉴别诊断的重要性。医疗保健提供者持续保持警惕并接受教育对于改善这种可治疗疾病的早期识别和管理至关重要。
