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Relapse of leprosy presenting as nodular lymph node swelling.
K U Kiran1, K V Krishna Moorthy, Vani Meher
1Medilab, Hyderabad, India.
Indian Journal of Dermatology, Venereology and Leprology
|March 19, 2009
Summary
Late relapse of lepromatous leprosy can present with significant nodular lymphadenopathy, mimicking other conditions. Prompt diagnosis and multidrug therapy (MDT) are crucial for effective treatment and symptom resolution.
Area of Science:
- Dermatology
- Infectious Diseases
- Clinical Medicine
Background:
- Leprosy, particularly lepromatous leprosy, is associated with lymphadenopathy.
- Nodular lymph node enlargement is an uncommon presentation in leprosy patients and is rarely reported during relapse.
Observation:
- A patient with lepromatous leprosy, previously treated for 22 years with multidrug therapy (MDT) until smear negativity, presented with significant nodular cervical lymphadenopathy and generalized lymphadenopathy.
- The presentation was initially misdiagnosed as tubercular lymphadenopathy.
Findings:
- A late bacteriological relapse of lepromatous leprosy was diagnosed, characterized by prominent lymphadenopathy and erythema nodosum leprosum (ENL).
- Treatment with WHO MDT multibacillary (MB) regimen and thalidomide led to rapid regression of nerve pain within 2 weeks and lymph node swelling within 3 months.
Implications:
- This case highlights the importance of considering leprosy relapse in patients with unexplained lymphadenopathy, even years after treatment completion.
- Prompt diagnosis and appropriate multidrug therapy (MDT) are essential for managing relapsed leprosy and associated complications like ENL and lymphadenopathy.
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