Question

Clinical Case 6

Hansen’s disease (leprosy)

A 56-year-old man was consulted for asymptomatic skin lesions on the right forearm, approximately three years old, associated with other similar injuries to the trunk and lower extremities, three months of evolution. The patient reported mild hypoesthesia in some plaques, without other associated symptoms. The patient had resided in Paraguay for eight years and had returned to Chile six years ago at the time of consultation.

On physical examination, the patient was in good general condition and had plaques and erythematous nodes and infiltrates in the malar areas, the forehead, nose, forearms, the anterior and posterior thorax and thighs, of symmetrical distribution. In addition, annular plates with raised edges and a tendency to central healing were observed in the right forearm, right thigh and back, with slight hypoesthesia in the center.

A skin biopsy showed granulomatous inflammation in the reticular dermis. The granulomas consisted of macrophages distributed mainly around blood vessels and nerve sheathes, with lymphocyte extension to the endoneurium. Kinyoun staining showed abundant intra and extracellular bacilli, compatible with M. leprae.

It was classified as a lepromatous borderline leprosy, and the standard treatment was started (dapsone 100 mg / d, rifampin 600 mg / d and clofazimine 300 mg / month), with good clinical response to the six months of treatment.

1. Which system is the target of Hansen Disease (Leprosy)?

2. What is the incidence of this disease, and which countries have higher prevalence?

3. Is any relation between this microorganism and Tuberculosis agent?

4. Which areas of the body are affected?

5. Which is the relation between tissue damage and immune system?

6. Why are people with Hansen’s disease unusually prone to injuring themselves?

Answer 1