Lepromatous leprosy: an elusive mimicker mistaken for polyarteritis nodosa and disseminated tuberculosis
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Keywords
Leprosy, polyarteritis nodosa, Vasculitis
Abstract
Leprosy is a chronic infectious disease caused by the obligate intracellular microorganism, Mycobacterium leprae and presents as skin lesions and peripheral neuropathies with upper respiratory mucosa involvement. We present a case of a 36-year-old immunocompromised female whom was recently diagnosed polyarteritis nodosa vasculitis (PAN) in Trinidad and returned back to the US with a two week history of pleuritic chest pain, fever, chills, fatigue, nausea, vomiting, epistaxis and cough. Physical examination revealed a diffuse rash. Pancytopenia prompted a bone marrow biopsy, which revealed acid-fast bacteria, suspicious for disseminated tuberculosis. Histologic examination of the skin lesions revealed disseminated acid-fast, Fite-positive microorganisms within the dermis and nerves. She developed anuric renal failure and purpura fulminans with disseminated intravascular coagulation (DIC). PCR results from the skin sample shortly thereafter revealed the presence of M. leprae DNA. Mycobacterium tuberculosis complex DNA was not identified.
This case demonstrates an unusual presentation of leprosy with bone marrow involvement and highlights the importance of utilizing histologic examination together with molecular diagnostic techniques to aid in establishing the correct diagnosis and treatment. This case also cautions that leprosy can be misdiagnosed as a vasculitis, specifically PAN, as there is overlap in the clinical presentation of each disease and that clinicopathologic correlation is essential.
References
2. Pardillo F, Fajardo T, Abalos R, Scollard D, Gelber R. Methods for the Classification of Leprosy for Treatment Purposes. Clinical Infectious Diseases. 2007; 44(8): 1096
3. National Hansen's Disease (Leprosy) Program Caring and Curing Since 1894. Health Resources and Services Administration. Last updated: 2018 May 1. Accessed: 2018 Oct 11. Retrieved from: https://www.hrsa.gov/hansens-disease/index.html.
4. Powell S, McDougall C. Clinical recognition of leprosy: some factors leading to delays in diagnosis. British medical journal. 1974; 1(5908): 612.
5. Misra DP, Parida JR, Chowdhury AC, et al. Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis. Case reports in immunology. 2014; 2014: 641989.
6. Naidoo S, Naicker VL. A demonstration of the similiarities and differences in bone marrow morphology with nontuberculous mycobacterial infections. International journal of laboratory hematology. 2015; 37(2): e19.
7. Somanath P, Vijay KC. Bone marrow evaluation in leprosy: clinical implications. Leprosy review. 2016; 87(1): 122.
8. Singh N, Bhatia A, Lakra A, Arora VK, Bhattacharya SN. Comparative cytomorphology of skin, lymph node, liver and bone marrow in patients with lepromatous leprosy. Cytopathology : official journal of the British Society for Clinical Cytology. 2006; 17(5): 257.
9. Sen R, Sehgal PK, Dixit V, et al. Lipid-laden macrophages in bone marrow of leprosy patients. Leprosy review. 1991; 62(4): 374.
10. Binitha MP, Saritha S, Riyaz N, Mary V. Pancytopenia due to lepromatous involvement of the bone marrow: successful treatment with multidrug therapy. Leprosy review. 2013; 84(2): 145.
11. Havey TC, Cserti-Gazdewich C, Sholzberg M, Keystone JS, Gold WL. Recurrent disseminated intravascular coagulation caused by intermittent dosing of rifampin. The American journal of tropical medicine and hygiene. 2012; 86(2): 264.
12. Chen G, He JQ. Rifampicin-induced disseminated intravascular coagulation in pulmonary tuberculosis treatment: A case report and literature review. Medicine. 2017; 96(7): e6135.
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