2009 Volume 119 Issue 1 Pages 23-31
A 28-year-old male Indonesian was referred to our department in September of 2006 with a 6-year history of a sensory loss on his left forearm. Physical examinations revealed a hypopigemented macule with hair loss on the left arm, painful swelling on the left little finger, and slight erythema with sensory loss on the left foot. A thickened left ulnar nerve with tingling was also confirmed. A biopsy taken from left forearm confirmed epithelioid granuloma around the deep dermal nerve in association with destruction of nerve fibers. Mycobacterium leprae was only found on one field with Fite stain. PCR test was positive. The diagnosis of BT (borderline tuberculoid)-type leprosy with reversal reaction was made, based on the above findings. The treatment was based on WHO/multidrug therapy combined with prednisolone, and ofloxacin was added because the disease was resistant to diaphenylsulfone. Swelling and pain improved, but the sensory loss persisted. Although leprosy is very rare nowadays in Japan, recognition of this disease is very important, because delay in diagnosis can result in severe damage to the peripheral nerves. Dermatologists play an important role in making an early diagnosis and treatment, and a biopsy extending into the subcutis to include the whole dermis should be performed, otherwise, the major finding in deep dermis will be missed.
