This article reports that a 60 year-old Korean male patient suffered from the type 1 lepra reaction of which the dominant manifestation was peripheral neuritis accompanied by secondary diabetes mellitus and hypothyroidism.
The patient has been hospitalized in National Leprosarium Oku-Komyoen since 1945, his case being diagnosed as lepromatous leprosy in 1944. As the result of the regular treatment, such as injection of Chaulmoogra oil and the following sulfone therapy, the skin lesions had been clearly absorbed by 1949. The patient, therefore, was regarded as a clinically cured case and the dapsone treatment had been regularly continued afterward till 1987.
About 6 years ago, the patient noticed drop foot which appeared insidiously on his left foot without neuralgia.
In October 1987, the patient began to suffer from left sciatica followed by neuralgia, sensory disorder and motor palsy on bilateral hands and the left of the face.
In January 1987, his blood sugar level went up to 520mg/dl, and it is considered that it resulted from secondary diabetes mellitus. We administrated insulin to him. After three months, blood sugar became normal. But symptoms of hypothyroidism were obse-rved in April; manifesting general fatigue, chill, anorrhexia, loss of body weight, constipation and so on. And besides he presented the ophthalmological symptom of iridocyclitis at the same time. Thyroid hormone was administrated. Symptoms of hypo-thyroidism have almost disappered now (August, 1988), though he has not recovered from his neural palsy yet.
In this case, neuritis, and iridocyclitis are thought to be due to the type 1 reaction, judging from the facts of the positive conversion of lepromin reaction (Mitsuda) and change of MLPA from negative to positive. Secondary diabetes mellitus and hypo-thyroidism subsequent to peripheral neuritis are also thought to be closely related with the immunological response associated with the type 1 lepra reaction, though the me-chanism is still unknown.
