Relapsed Type II Lepromatous Reaction With Drug-Induced Hemolysis: A Case Report Highlighting Therapeutic Challenges

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (ML), and it is also known as Hansen's disease. It is transmitted mainly through prolonged close contact with an untreated infected person. The disease primarily affects the skin and peripheral nerves. Leprosy can, however, present with a broad spectrum of clinical manifestations depending on the host's immune response, ranging from localized tuberculoid disease to disseminated lepromatous disease. Diagnosis of leprosy relies primarily on clinical findings and is supported by histopathological examination of a skin biopsy. Management requires multidrug therapy (MDT), treatment of lepra reactions, and rehabilitation. We report the case of a 27-year-old female with lepromatous leprosy complicated by a severe type two lepra reaction involving multiple organ systems. The treatment regimen was complicated by hemolysis caused by dapsone therapy despite normal glucose-6-phosphate dehydrogenase (G6PD) activity. This report highlights significant therapeutic challenges and provides important insights into the management of leprosy reactional states.