Atypical cinical manifestation of leprosy in Indonesian male adolescent: a case report

  • Dion Darius Samsudin Faculty of Medicine, University of Indonesia
  • Mulya Rahma Karyanti Department of Child Health, Tropical Infectious Disease Department, Univeristy of Indonesia Medical School
DOI: https://doi.org/10.14238/pi61.3.2021.175-8
Keywords: Leprosy, Hansen's disease, Erythema nodusum leprosum, Atypical, adolescent

Abstract

Leprosy, also known as Hansen’s disease, is a chronic infectious disease with high prevalence, but often neglected in Indonesia. Indonesia ranks the 3rd worldwide, after India and Brazil, with 17,439 new cases reported in 2019.1 This disease is caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus, which mainly affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes. Early diagnosis of the disease is fundamental, because delayed treatment may lead to severe deformities and disabilities.2 The current multidrug treatment (MDT) for leprosy is widely available in Indonesia for free.

According to the World Health Organization (WHO),1 leprosy is one of 20 diseases recognised as neglected tropical diseases (NTDs), a group of disease which present significant burden amongst the poorest, often unheard communities. Eradication of leprosy is challenging because of the difficulty in diagnosis, as leprosy imitates various diseases, as well as treatment delay, high transmission, and social stigma. The regions of highest leprosy prevalence in Indonesia are in Java, Sulawesi, Maluku, and Papua.3,4

Among 17,439 new cases in 2019, 1,861 (10%) were children under 15 years of age.1 The detection of new cases in children indicates high transmission, and lack of mechanisms to control endemic infections.2 The aim of this report is to share our experience in diagnosing advanced stage leprosy with atypical clinical characteristics in a male adolescent. 

References

1. World Health Organization. Global Health Observatory (GHO) data: Leprosy. World Health Organization. 2020. [cited 2021 March 31]. Available from: https://apps.who.int/gho/data/node.main.A1639?lang=en
2. Oliveira MBB, Diniz LM. Leprosy among children under 15 years of age: literature review. An Bras Dermatol. 2016;91:196-203. DOI: 10.1590/abd1806-4841.20163661.
3. Tosepu R, Gunawan J, Effendy DS, Fadmi FR. Stigma and increase of leprosy cases in SouthEast Sulawesi Province, Indonesia. Afr Health Sci. 2018;18:29-31. DOI: 10.4314/ahs.v18i1.5.
4. Ramona F, Sutrisna EM. Leprosy: an overview of epidemiology and risk factor in Indonesia. J Bio Innov. 2017;6:991-5. ISSN-e 2277-8330.
5. Bishop PJ, Neumann G. The history of the Ziehl-Neelsen stain. Tubercle. 1970;51:196-206. DOI: 10.1016/0041-3879(70)90073-5.
6. Morello J, Granato P, Morton V. Laboratory manual and workbook in microbiology: applications to patient care. 10th ed. Boston: McGraw-Hill Higher Education; 2006. p.151-3.
7. Kosasih A, Wisnu IM, Sjamsoe-Daili E, Menaldi SL. Kusta. In: Djuanda A, Hamzah M, Aisah S, eds. Ilmu penyakit kulit dan kelamin. 5th ed. Jakarta: Balai Penerbit FKUI; 2007. p. 77-88.
8. Guidelines for the diagnosis, treatment and prevention of leprosy. New Delhi: World Health Organization, Regional office for South-East Asia; 2017. License: CC BY-NC-SA 3.0 IGO. [cited 2019 October 11]. Available from: nlep.nic.in/pdf/who%20Guidelines%[email protected]
9. Negera E, Walker SL, Girma S, Doni SN, Tsegaye D, Lambert SM, et al. Clinico-pathological features of erythema nodusum leprosum: a case-control study at ALERT hospital, Ethiopia. PLoS Negl Trop Dis. 2017;11:e0006011. DOI: 10.1371/journal.pntd.0006011. eCollection 2017 Oct.
10. Hsieh TT, Wu YH. Leprosy mimicking lupus erythematosus. Dermatol Sin. 2014;32:47-50. DOI: https://doi.org/10.1016/j.dsi.2013.01.004.
11. Chao G, Fang L, Lu C. Leprosy with ANA positive mistaken for connective tissue disease. Clin Rheumatol. 2013;32:645-8. DOI: 10.1007/s10067-013-2163-0.
12. Zhu J, Yang D, Shi C, Jing Z. Therapeutic dilemma of refractory erythema nodosum leprosum. Am J Trop Med Hyg. 2017;96:1362-4. DOI: 10.4269/ajtmh.16-0118.
Published
2021-04-29
How to Cite
1.
Samsudin D, Karyanti MR. Atypical cinical manifestation of leprosy in Indonesian male adolescent: a case report. PI [Internet]. 29Apr.2021 [cited 22Nov.2024];61(3):175-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2336
Issue
Vol 61 No 3 (2021): May 2021
Section
Case Report

Copyright (c) 2021 Dion Darius Samsudin, Mulya Rahma Karyanti

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Received 2019-10-12
Accepted 2021-04-29
Published 2021-04-29