Localized lepromatous leprosy and its response to chemo-immunotherapy

Beena, K. R. ; Zaheer, S. A. ; Guleria, I. ; Mukherjee, R. ; Talwar, G. P. ; Mukherjee, A. ; Ramesh, V. ; Misra, R. S. (1994) Localized lepromatous leprosy and its response to chemo-immunotherapy International Journal of Dermatology, 33 (1). pp. 64-67. ISSN 0011-9059

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Official URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-...

Related URL: http://dx.doi.org/10.1111/j.1365-4362.1994.tb01501.x

Abstract

Background. This is an unusual presentation of lepromatous leprosy (ll) in a young boy, 12 years of age. The study forms part of a large scale immunotherapeutic trial with Mycobacterium w (M.w) antileprosy vaccine. The trial is being conducted in two major hospitals in New Delhi, India. Materials and Methods. This patient presented with three lesions: one on each forearm and the third on the left leg. He was classified initially as borderline tuberculoid leprosy. Slit-skin smears and histopathology from the lesions proved the diagnosis to be lepromatous leprosy with a bacterial index (bi) 6+. The initial lepromin test was negative. The patient was treated with chemo-immunotherapy (standard multidrug therapy and immunotherapy with Mycobacterium w vaccine). Results. Investigations after 1 year (15 months) of multidrug therapy and three doses of vaccine, showed a remarkable fall in the bi from 6 to 0 in the lesions, a lepromin positivity of 5 mm, and a histological upgrading from lepromatous leprosy to borderline tuberculoid. Immunologic studies at 15 months revealed a good LTT response and high levels of cytokines, specifically IL-2 and IFN-γ. Conclusions. This report presents an LL patient with disease limited to a few sites. It stresses the importance of slit-smear and biopsy in all patients of leprosy, and it highlights the upgrading observed on administration of chemo-immunotherapy.

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