Systemic Lupus Erythematosus Complicated with Mycobacterium Leprae Infection: a Rare Case Report

Area of Science:

• Dermatology
• Infectious Diseases
• Immunology

Background:

• Systemic lupus erythematosus (SLE) can present with diverse dermatological manifestations.
• Co-infection with Mycobacterium leprae (leprosy) in SLE patients is exceptionally rare and poses diagnostic challenges.
• A patient with a history of syphilis and maternal leprosy developed new skin lesions during SLE management.

Observation:

• The patient presented with extensive patchy erythema, itching, and subcutaneous masses on the hands.
• Skin biopsy revealed histiocytic infiltration and inflammation consistent with leprosy.
• Acid-fast staining and mNGS confirmed Mycobacterium leprae in tissue samples.

Findings:

• The patient was diagnosed with borderline leprosy and subacute cutaneous lupus erythematosus.
• Treatment involved methylprednisolone, rifampicin, and dapsone, leading to clinical improvement.
• Diagnostic difficulties arose due to overlapping skin symptoms of SLE and leprosy.

Implications:

• This case underscores the importance of considering co-infections in immunocompromised patients, especially those with a history of exposure.
• Advanced diagnostics like mNGS are vital for identifying unusual pathogens like Mycobacterium leprae.
• Integrated treatment strategies are necessary for managing complex cases involving autoimmune diseases and infectious agents.