Lepromatous Leprosy : a case report of Type II reaction Erythema Nodosum Leprosum

Abstract

Introduction: Leprosy, caused by the obligate intracellular pathogen Mycobacterium leprae, manifests as a chronic infectious disease predominantly affecting the skin and peripheral nerves. Immunological reactions in response to Leprosy are typically divided into two categories (1) a cell-mediated response and (2) a delayed immune-complex mediated response. Drug adherence is crucial, but often difficult for each patient facing this condition. Case Presentation: A 25-year-old male from originally from Micronesia, moved to Hawaii in 2020 and then to Springfield, MO, in 2021 for a construction job. He presented to urgent care with a 2-week history of a diffuse erythematous rash with hypopigmented macules, nodules, and plaques distributed across his extremities, trunk, and face. The patient also had tender nodules and peripheral neuropathy of his left index and middle finger. Results: A newly studied regimen was initiated including once monthly dose of Rifampin, Moxifloxacin, and Minocycline. In addition to the antibiotics, methotrexate and prednisone was added weekly for the management of inflammation for a total of 12-24 month duration of treatment. Conclusion: Multidrug therapy recommended by the World Health Organization includes daily doses of rifampicin and dapsone and monthly doses of clofazimine for 6-12 months. Rather than continuing to use a 40 year old regimen, the development of personalized treatment should be prioritized due to the different needs, ages, co-morbidities, and issues with non-compliance while using new, more modern medications.