Type 2 Lepra Reaction Following Antituberculosis Treatment Initiation in an Elderly Male With Coexisting Hansen's...

Tuberculosis and leprosy coinfection is increasingly rare even in endemic areas. We report a 70-year-old male presenting with fever and malaise. Pulmonary tuberculosis was suggested by chest computed tomography scan and confirmed on polymerase chain reaction testing of bronchial wash specimens. Skin punch biopsies were consistent with lepromatous Hansen's disease. After initiating isoniazid, rifampicin, pyrazinamide and ethambutol, he developed new erythematous patches and plaques on the lower extremities and required supplemental oxygen. Erythema nodosum leprosum was diagnosed. Intravenous hydrocortisone, dapsone and clofazimine were started, and clinical improvement and decreased inflammatory markers followed. The patient was discharged with a 20-week course of prednisone and multidrug treatment for drug-susceptible pulmonary tuberculosis and leprosy. Concomitant Hansen's disease should be considered when treating patients for tuberculosis especially in areas where both are prevalent as different long-term multidrug regimens are required.