Ocular and Periocular Leprosy Confirmed by Polymerase Chain Reaction and Histopathology with Therapeutic Insights

Mycobacterium leprae commonly affects organs such as skin, peripheral nerves, joints and eyes. However, its intraocular presence has not been documented before. Through our retrospective case report, we aim to raise the awareness of the possibility of intraocular invasion by Mycobacterium leprae.

A 56-year-old male, diagnosed with left periocular leprosy at our medical centre, developed pain, redness, and diminution of vision while still on Multi-Drug Therapy (MDT). On examination, he had corneal ulceration, corneal melt, and endophthalmitis. He underwent emergent therapeutic keratoplasty with lateral tarsorrhaphy and multiple intravitreal injections.

Histopathological examination of cornea using Ziehl-Neelsen and Fite-Faraco staining techniques revealed the presence of acid-fast bacilli in the corneal epithelium and anterior stroma. The Descemet's membrane was intact with an adherent endothelial plaque-like hypopyon, which also showed positivity for Lepra bacilli on special stains. The corneal button, hypopyon, and vitreous sample tested positive for Mycobacterium leprae detected via polymerase-chain reaction (PCR). He was started on topical fortified imipenem drops & intravitreal Vancomycin + Imipenem + Dexamethasone. USG-B scan after 48 h showed marked improvement with a few moderate dot echoes. Intravitreal injections were repeated every 48 h for 2 weeks, with serial USG B scans showing significant reduction in vitreous echoes.

This case report thus provides evidence that Mycobacterium leprae can indeed penetrate the ocular coats despite a good immune response & Multi-Drug Therapy. Intravitreal injection Imipenem seems to be an effective drug choice in the management of Mycobacterium leprae endophthalmitis.