Two microbiological relapses in a patient with lepromatous leprosy

Area of Science:

• Dermatology
• Infectious Diseases
• Microbiology

Background:

• Leprosy, a chronic infectious disease, historically posed significant treatment challenges.
• Dapsone monotherapy was a primary treatment before the advent of multidrug therapy (MDT).
• Relapse after treatment completion remains a concern in leprosy management.

Observation:

• A patient with lepromatous leprosy achieved smear negativity after over 6 years of dapsone treatment.
• The patient relapsed 5 years post-treatment, subsequently receiving WHO-MDT for multibacillary leprosy.
• A second relapse occurred 17 years after stopping WHO-MDT, presenting as borderline leprosy with reaction.

Findings:

• Successful treatment leading to smear negativity does not guarantee permanent cure for leprosy.
• Recurrence of leprosy can occur years after completing both dapsone monotherapy and WHO-MDT.
• Leprosy relapse can manifest with different clinical presentations, including borderline leprosy with reaction.

Implications:

• Long-term surveillance is crucial for leprosy patients, even after achieving negative smears and completing treatment.
• The potential for late relapses necessitates ongoing vigilance in endemic areas.
• Understanding relapse patterns can inform future treatment strategies and follow-up protocols for leprosy.