Adjunctive rifampicin-ofloxacin therapy in histoid Hansen disease with high bacillary burden: a case report

Histoid Hansen disease is a distinct variant of lepromatous leprosy characterized by nodular lesions, spindle-shaped histiocytes and a very high bacillary load, often associated with relapse and drug resistance. While standard multibacillary multidrug therapy (MB-MDT) remains the mainstay of treatment, very short-course bactericidal regimens appear inadequate in bacillary-rich disease. We report a case of histoid leprosy treated with adjunctive rifampicin and ofloxacin for 3 months alongside MB-MDT, resulting in marked clinical regression. Although causality cannot be inferred from a single case, this observation suggests a potential role for short-term intensified bactericidal therapy as an adjunct in selected high-risk morphological variants.