Relapses in Lepromatous Leprosy

Abstract

It is well known that the relapses of lepromatous or borderline cases of leprosy occur even after the patients are treated sufficiently and regularly and followed-up carefully for several years.
In this article the author presents four cases of leprosy. Three of them are relapsed cases of lepromatous leprosy. The treatment of these three cases was analyzed and the inducing factors for the relapse were discussed. One of them was a suspected case and the result of the smear of the skin was discussed with reference to the early signs of the relapses.
Three cases, one male and two female cases, had some new skin lesions in 1983, one case in spring and two in autumn. One patient was treated at irregular intervals before the relapse occurred and the treatment was already discontinued due to anemic condition with general weakness in one case. In one case any noticeable changes were seen during the course of the treatment. The remaining case did not have a clinical manifestation of the relapse up to the present time but recently the smear examination of the skin for the acid-fast bacilli repeatedly demonstrated slight positive tests in this case.
The subjective signs were characterized by the swelling of the face, nasal obstruction, some erythematous patches with itching of the trunk and extremities. Sleepiness with general fatigue would be one of the most special and noticeable signs of the relapses.
Objectively, a mild or moderate degree of infiltration in the face and various sizes of a few or several erythematous patches on the trunk and the extremities were usually observed.
The causes for the relapses are usually inconsistency and insufficiency of the treatment. At present, in Japan, most patients are cured and the guidelines for the treatment were established, but it should be noticeable that after the long period of negative acid-fast bacilli a few cases have the possibility of the relapses especially in the lepromatous cases. From this point of view, it should be emphasized that the careful and repeated observation must be done even for the cases whose treatment has stopped for a long time after a sufficient and long-term, regular treatment. For these reasons, the above mentioned characteristic signs shouid be very carefully observed and noticed by the physicians, paramedical staffs and family of the patients.