Type 2 reaction associated sensorineural hearing loss in a drug resistant lepromatous leprosy patient: A case report

Rationale:Leprosy,a chronic granulomatous disease often present clinically as erythema nodosum leprosum,a type 2 reaction.The involvement of cochlear part of audiovestibular system is a rarity.Patient concerns:A 26-year-old male patient with lepromatous leprosy developed bilateral sensorineural hearing loss(SNHL)during type 2 reactional episode.Diagnosis:Recurrent erythema nodosum leprosum in rifampicin-resistant lepromatous leprosy.Interventions:Corticosteroids and second-line multidrug therapy.Outcomes:The patient improved significantly and was further referred for management of psychosocial impact due to sensorineural hearing loss.Lessons:The hearing impairment is a rare complication of type 2 reaction.Any patient with suspected cranial nerve involvement should essentially be screened by tuning fork tests for early detection of hearing impairment and offer timely intervention as required.All high bacteriological index cases should be investigated for antimicrobial resistance in high endemic areas.

Can baseline ML Flow test results predict leprosy reactions? An investigation in a cohort of patients enrolled in the uniform multidrug therapy clinical trial for leprosy patients in Brazil

Background:The predictive value of the serology to detection of IgM against the Mycobacterium leprae-derived phenolic glycolipid-I/PGL-I to identify leprosy patients who are at higher risk of developing reactions remains controversial.Whether baseline results of the ML Flow test can predict leprosy reactions was investigated among a cohort of patients enrolled in The Clinical Trial for Uniform Multidrug Therapy for Leprosy Patients in Brazil(U-MDT/CT-BR).Methods:This was a descriptive study focusing on the main clinical manifestations of leprosy patients enrolled in the U-MDT/CT-BR from March 2007 to February 2012 at two Brazilian leprosy reference centers.For research purposes,753 leprosy patients were categorized according to a modified Ridley-Jopling(R&J)classification and according to the development of leprosy reactions(reversal reaction/RR and erythema nodosum leprosum/ENL),and whether they had a positive or negative bacillary index/BI.Results:More than half of the patients(55.5%)reported leprosy reaction:18.3%(138/753)had a RR and 5.4%(41/753)had ENL.Leprosy reactions were more frequent in the first year following diagnosis,as seen in 27%(205/753)of patients,while 19%(142/753)developed reactions during subsequent follow-up.Similar frequencies of leprosy reactions and other clinical manifestations were observed in paucibacillary(PB)and multibacillary(MB)leprosy patients treated with U-MDT and regular MDT(R-MDT)(P=0.43 and P=0.61,respectively).Compared with PB patients,leprosy reactions were significantly more frequent in MB patients with a high BI,and more patients developed RR than ENL.However,RR and neuritis were also reported in patients with a negative BI.At baseline,the highest rate of ML Flow positivity was observed in patients with a positive BI,especially those who developed ENL,followed by patients who had neuritis and RR.Among reaction-free patients,81.9%were ML Flow positive,however,the differences were not statistically significant compared to reactional patients(P=0.45).Conclusions:MB and PB patients treated with R-MDT and U-MDT showed similar frequencies of RR and other clinical manifestations.Positive ML Flow tests were associated with MB leprosy and BI positivity.However,ML Flow test results at baseline showed limited sensitivity and specificity for predicting the development of leprosy reactions.

A rare case of type 1 leprosy reactions following tetanus infection in a borderline tuberculoid leprosy patient and a literature review

Background:Type 1 leprosy reaction,also known as“reversal reaction”,is related to cellular immune responses to Mycobacterium leprae antigens.The risk factors that trigger type 1 leprosy reactions are poorly understood.Leprosy with concurrent tetanus is rare,and there are no publicly available reports of a leprosy patient infected with tetanus that induced type 1 leprosy reactions.Case presentation:A 56-year-old Chinese Han female presented to our hospital with symptoms of erythematous plaques and pain over her left upper limb for 2 days and foreign object sensation in her throat for 3 days.The patient had a 6-year history of leprosy.Type 1 leprosy reactions were initially considered,followed by treatment with methylprednisolone.Two days later,the patient’s symptoms were aggravated,with neck muscle tension and difficulty in opening her mouth,and the erythematous plaques had spread over most of her left upper limb.After further careful examinations,we confirmed the diagnosis of tetanus with concurrent type 1 leprosy reactions.The patient was given anti-tetanus treatment for 12 days and anti-leprosy reaction treatment for 4 months;the diseases were eventually controlled.Conclusions:This report suggests that tetanus infection may be a trigger for type 1 leprosy reactions.