Essential Aspects of Leprosy Classification and Clinical Course of Five Leprosy Patients, Including Four Relapsed Cases

The clinical course of leprosy varies depending on the level of host cell-mediated immunity to the causative agent, Mycobacterium leprae. In this study, the diagnostic aspects of the classification of the disease in five leprosy patients are presented alongside their clinical courses. The lepromatous leprosy (LL) Case presented with many erythematous plaques without anesthesia; pathology revealed the presence of abundant acid-fast bacilli (AFB). The patient developed reversal reactions during chemotherapy, and was diagnosed with subpolar LL. In this Case, resistance to three drugs was found. One borderline-tuberculoid (BT) leprosy Case had asymmetrically arranged multiple annular lesions, and another had one large erythematous lesion with small satellites. All these lesions were anesthetic, and the pathological findings revealed epithelioid granulomas; these clinicopathological findings are characteristic of BT leprosy. Another BT leprosy Case presented with neuralgia at the first visit, and on nerve biopsy, some nerve fascicles presented the feature of a reversal reaction. However, another nerve fascicle was found to be almost intact and showed positive staining in immunohistochemistry for M. leprae-specific phenolic-glycolipid I, although AFB were not found. In all three BT Cases, the slit-skin smears were negative. The borderline lepromatous (BL) leprosy Case involved numerous symmetric annular lesions with a characteristic punched-out feature. Loss of sensation was apparent in annular lesions. The smear tested positive, and abundant AFB were found inside the foamy Schwann cells. The differences in the clinical features of each patient reflect their immunity to the causative bacilli. In all, four Cases of the B-group were treated with the World Health Organization-recommended multibacillary regimen. One patient with BT leprosy developed anaphylactic shock against rifampicin (RFP). The monthly dose of RFP should therefore be administered following the direct observation procedure. The appropriate duration of chemotherapy for leprosy, especially in drug-resistant cases, should be studied further.