Borderline type leprosy with variation of clinical manifestations and histopathology: two case reports

I Gusti Ayu Agung Dwi Karmila; Luh Made Mas Rusyati; Herman Saputra; Luh Gede Melia Puspita Sari

doi:10.15562/bmj.v12i3.4572

Borderline type leprosy with variation of clinical manifestations and histopathology: two case reports

I Gusti Ayu Agung Dwi Karmila ,

Luh Made Mas Rusyati ,

Herman Saputra ,

Luh Gede Melia Puspita Sari ,

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DOI: https://doi.org/10.15562/bmj.v12i3.4572 |
Published: 2023-08-21

Abstract

Link of Video Abstract: https://youtu.be/HgIJyHrxoOc

Background: Leprosy is a chronic disease caused by Mycobacterium leprae. This disease can be diagnosed if one of the four criteria is met. Histopathological examination can vary depending on the spectrum of the disease. The following describes two cases of borderline-type leprosy that aimed to increase understanding of the diagnosis and management of leprosy, especially the borderline type.

Cases: Both cases had complaints of numb spots on the body. The first case had more lesions than the second one with borderline-borderline histopathological examination results, while the second one had borderline lepromatous histopathological examination results. Both patients received the same therapy (multidrug therapy for multibacillary leprosy). During observation, there were no drug side effects that the patient could not tolerate. The prognosis in both cases is dubia, depending on the patient's adherence to treatment.

Conclusion: The diversity of clinical and histopathological features can occur, including cases of leprosy. Early diagnosis and prompt treatment should be started as possible to prevent disabilities.

References

World Health Organization. Global leprosy (Hansen disease) update, 2021: moving towards interruption of transmission. 2021 (cited: February, 24th 2023). Available from: https://www.who.int/publications/i/item/who-wer9736-429-450
Schreuder PAM, Noto S, Richardus JH. Epidemiologic trends of leprosy for the 21st century. Clin Dermatol. 2016;34(1):24–31.
Anonim. Register of Dermatology and Venereology Outpatient Clinic (Morbus Hansen Division) Prof. dr. I G. N. G. Ngoerah Hospital. Denpasar; 2021.
Salgado CG, Brito AC, Salgado UI SJ. Leprosy. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ OJ, editor. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw-Hill; 2019. p. 2892–924.
Kumar B, Dogra S. Case Definition and Clinical Types of Leprosy. In: Kumar B KH, editor. IAL Texbook of Leprosy. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2017. p. 236–53.
Akpolat ND, Akkus A, Kaynak E. An Update on the Epidemiology, Diagnosis and Treatment of Leprosy. Hansen Dis - Forgot Neglected Dis. 2019:1-5.
Barua JK, Khan S, Chandra A, Dhabal A, Halder S. Clinico-epidemiological profile of adult leprosy patients from a referral hospital in Eastern India: A retrospective study. J Pakistan Assoc Dermatologists. 2021;31(2):158–64.
Fischer M. Leprosy – an overview of clinical features, diagnosis, and treatment. JDDG - J Ger Soc Dermatology. 2017;15(8):801–27.
Alinda MD, Geani S, Agusni RI, Kusumaputra BH, Reza NR, Prakoeswa CRS, et al. Diagnosis and Management of Leprosy. Periodical of Dermatology and Venereology. 2020;32(2):149–57.
Walker SL, Withington SG, Lockwood DNJ. Leprosy. Manson’s Trop Dis Twenty-Third Ed. 2013;506–18.
Ilyas F. Discrepancy between Clinical Manifestations and Histopathological Features in Borderline Borderline Leprosy. Int J Med Rev Case Reports. 2019;3(5):286-289
Abideen F, Balakrishnan S, Sindhu CB, George S, Sanker A. A unique case of borderline lepromatous leprosy presenting with both hypopigmented and hyperpigmented macules. Lepr Rev. 2021;92(4):412–20.
Hacker MA, Sales AM, Duppre NC, Sarno EN, Moraes MO. Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients. Sci Rep. 2021;11(1):1–7.
World Health Organization. Global leprosy (Hansen disease) update, 2019: time to step-up prevention initiatives. Weekly epidemiological record. 2020;95(36): 417-440.
Lockwood DNJ. Leprosy. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook’s Textbook of Dermatology. 9th ed. UK: John Wiley & Sons, Ltd; 2016. p. 28.1-28.18.
Rusyati LMM, Sasmita PA, Adiguna MS. Diagnostic test using monofilament compared to electroneuromyography (ENMG) for detection of peripheral neuropathy in leprosy at Sanglah General Hospital, Bali-Indonesia. Bali Med J. 2019;8(3):722–7.
Conceição R, Penna MLF. History and Perspective of the Uniform Multidrug Therapy for All Patients. An Bras Dermatol. 2017;92(6):761–73.
James DW, Elston DM, Treat JR, Rosenbach MH NI. Hansen Disease. In: Andrew’s Diseaseas of The Skin. 13th ed. Elsevier Inc.; 2020. p. 336–9.
Valerio do Nascimento L, Fattori Assed Saad C, Burdick AE, Camacho ID, Scollard DM, Motta RN, et al. Mycobacteria. Trop Dermatology Second Ed. 2016;252–79.
Hall BJ, Cockerell CJ. Leprosy. In: Nonneoplastic Dermatopathology. 2nd ed. New York: Elsevier; 2017. p. 544–8.
Mayasari R, R S. Diagnosis Klinis Morbus Hansen Tipe Mid Borderline (BB) dengan Gambaran Histopatologis Morbus Hansen Tipe Borderline Tuberculoid (BT). J Kedokt Kesehat Publ Ilm Fak Kedokt Univ Sriwij. 2019;6(2):57–62.
Manandhar U, Adhikari SC, Sayami G. Clinico-histopathological correlation of skin biopsies in leprosy. J Pathol Nepal. 2013;3:452–8.
Lowe C. Basic Knowledge on Leprosy: A Short Review. J Biomed Res Environ Sci. 2021;2(5):345–9.
Bhandari J, Awais M, Robbins BA, Gupta V. Leprosy. StatPearls Publishing LLC. 2022:1-22.

[1] World Health Organization. Global leprosy (Hansen disease) update, 2021: moving towards interruption of transmission. 2021 (cited: February, 24th 2023). Available from: https://www.who.int/publications/i/item/who-wer9736-429-450

[2] Schreuder PAM, Noto S, Richardus JH. Epidemiologic trends of leprosy for the 21st century. Clin Dermatol. 2016;34(1):24–31.

[3] Anonim. Register of Dermatology and Venereology Outpatient Clinic (Morbus Hansen Division) Prof. dr. I G. N. G. Ngoerah Hospital. Denpasar; 2021.

[4] Salgado CG, Brito AC, Salgado UI SJ. Leprosy. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ OJ, editor. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw-Hill; 2019. p. 2892–924.

[5] Kumar B, Dogra S. Case Definition and Clinical Types of Leprosy. In: Kumar B KH, editor. IAL Texbook of Leprosy. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2017. p. 236–53.

[6] Akpolat ND, Akkus A, Kaynak E. An Update on the Epidemiology, Diagnosis and Treatment of Leprosy. Hansen Dis - Forgot Neglected Dis. 2019:1-5.

[7] Barua JK, Khan S, Chandra A, Dhabal A, Halder S. Clinico-epidemiological profile of adult leprosy patients from a referral hospital in Eastern India: A retrospective study. J Pakistan Assoc Dermatologists. 2021;31(2):158–64.

[8] Fischer M. Leprosy – an overview of clinical features, diagnosis, and treatment. JDDG - J Ger Soc Dermatology. 2017;15(8):801–27.

[9] Alinda MD, Geani S, Agusni RI, Kusumaputra BH, Reza NR, Prakoeswa CRS, et al. Diagnosis and Management of Leprosy. Periodical of Dermatology and Venereology. 2020;32(2):149–57.

[10] Walker SL, Withington SG, Lockwood DNJ. Leprosy. Manson’s Trop Dis Twenty-Third Ed. 2013;506–18.

[11] Ilyas F. Discrepancy between Clinical Manifestations and Histopathological Features in Borderline Borderline Leprosy. Int J Med Rev Case Reports. 2019;3(5):286-289

[12] Abideen F, Balakrishnan S, Sindhu CB, George S, Sanker A. A unique case of borderline lepromatous leprosy presenting with both hypopigmented and hyperpigmented macules. Lepr Rev. 2021;92(4):412–20.

[13] Hacker MA, Sales AM, Duppre NC, Sarno EN, Moraes MO. Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients. Sci Rep. 2021;11(1):1–7.

[14] World Health Organization. Global leprosy (Hansen disease) update, 2019: time to step-up prevention initiatives. Weekly epidemiological record. 2020;95(36): 417-440.

[15] Lockwood DNJ. Leprosy. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook’s Textbook of Dermatology. 9th ed. UK: John Wiley & Sons, Ltd; 2016. p. 28.1-28.18.

[16] Rusyati LMM, Sasmita PA, Adiguna MS. Diagnostic test using monofilament compared to electroneuromyography (ENMG) for detection of peripheral neuropathy in leprosy at Sanglah General Hospital, Bali-Indonesia. Bali Med J. 2019;8(3):722–7.

[17] Conceição R, Penna MLF. History and Perspective of the Uniform Multidrug Therapy for All Patients. An Bras Dermatol. 2017;92(6):761–73.

[18] James DW, Elston DM, Treat JR, Rosenbach MH NI. Hansen Disease. In: Andrew’s Diseaseas of The Skin. 13th ed. Elsevier Inc.; 2020. p. 336–9.

[19] Valerio do Nascimento L, Fattori Assed Saad C, Burdick AE, Camacho ID, Scollard DM, Motta RN, et al. Mycobacteria. Trop Dermatology Second Ed. 2016;252–79.

[20] Hall BJ, Cockerell CJ. Leprosy. In: Nonneoplastic Dermatopathology. 2nd ed. New York: Elsevier; 2017. p. 544–8.

[21] Mayasari R, R S. Diagnosis Klinis Morbus Hansen Tipe Mid Borderline (BB) dengan Gambaran Histopatologis Morbus Hansen Tipe Borderline Tuberculoid (BT). J Kedokt Kesehat Publ Ilm Fak Kedokt Univ Sriwij. 2019;6(2):57–62.

[22] Manandhar U, Adhikari SC, Sayami G. Clinico-histopathological correlation of skin biopsies in leprosy. J Pathol Nepal. 2013;3:452–8.

[23] Lowe C. Basic Knowledge on Leprosy: A Short Review. J Biomed Res Environ Sci. 2021;2(5):345–9.

[24] Bhandari J, Awais M, Robbins BA, Gupta V. Leprosy. StatPearls Publishing LLC. 2022:1-22.

Borderline type leprosy with variation of clinical manifestations and histopathology: two case reports

Abstract

References

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