Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction

Nishikant Borse, V. Borse, T. Borse, Shiamak Cooper
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Abstract

A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to Mycobacterium leprae (M. leprae) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.
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视神经病变和巩膜炎是Lepra反应的表现特征
麻风病患者管理中的一个主要问题是“反应”的发生。这些反应是对麻风分枝杆菌(M. leprae)的动态免疫反应的结果,可能发生在多药治疗(MDT)之前、期间或之后。它们可分为两种类型- 1型麻风反应和2型麻风反应,也称为麻风结节性红斑(ENL)。我们报告一个不寻常的情况下,一个35岁的男性患者谁最初提出投诉中央暗斑。他既没有可见的麻风皮肤病变,也没有完成或同时进行抗麻风药物治疗的历史。他被诊断为前路缺血性视神经病变,他接受静脉注射甲基强的松龙治疗,他有明显的反应。两个月后,他主诉视力减退,左眼发红、疼痛,诊断为巩膜炎。患者局部使用醋酸泼尼松龙滴眼液。一周之内,病人的颧骨、耳部和手背都出现了皮肤损伤。他被介绍给一位风湿病学家和一位皮肤科医生。皮肤科医生怀疑这些病变是Lepra反应的表现。在对凸起的病变进行活检后证实存在麻风杆菌,结果证明他是一例未确诊的麻风性麻风。随后,根据世卫组织mdt - mb,他接受了抗麻风病药物治疗,并服用了类固醇。开始这种治疗三个月后,他的眼部和皮肤病变完全消失。这是一个独特的病例,其中前缺血性视神经病变和巩膜炎先于麻风病的症状,表现为皮肤病变。
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