Search

We report a 74-year-old Japanese man who occurred leprosy at the age of 68. He moved to Bolivia at the age of 33 as an immigrant. He complained erythematous plaques on his trunk and extremeties and dysuria. Skin biopsy specimen revealed granulomatous lesions and acid fast staining showed numerous number of positively stained bacilli. He was diagnosed as multibacillary leprosy and MDT containing DDS, RFP, and CLF was started. During the treatment, he developed borderline reaction twice presenting severe pain and marked swelling on his hand and foot. The reaction was successfully treated with daily dose of 50 mg prednisolone combined with anti-leprosy drugs. SPFX, MINO, and CAM were not able to be used due to the side effects. One year has been passed after the stop of treatment without relapse.

We report two cases of Hansen's disease. Case 1 was 71-year old Japanese man who developed left ulnar nerve palsy since 7 years ago, multiple erythema on his body since 2-3 years ago, and erythematous nodules on his face since 3 months ago. He had no history of living outside Ibaraki prefecture. The clinical feature, the skin biopsy, laboratory data showed that he had borderline lepromatous leprosy. He was treated with multi-drug therapy which was effective and was stopped 3 years after the bacterial index showed negative. Ten months later, erythema on his body and face appeared and the therapy was restarted. Case 2 was 68-year old Japanese man who developed 5 cm of nummular erythema with slight numbness on his right forearm since 3 months ago. He had lived in Brazil since he was 24 to 64 years old. The skin biopsy showed epithelioid cell granuloma in the dermis involving vessels and nerves. Polymerase chain reaction test showed the M.leprae DNA, and he was diagnosed as indeterminate leprosy. He was treated with dapson and rifampicin and 2 months later, erythema and numbness disappeared.

The presence of acid-fast bacilli in the lesion and its positive culture usually provide the diagnosis in cutaneous mycobacteriosis. But in diagnosis of leprosy, characteristic clinico-histopathological findings are so important as the demonstration of the organism, because of the failure to grow Mycobacterium leprae in vitro. It is classified in various forms along a spectrum of infectious and immunological symptoms supported by the pathogen-host relationship. The patient was a Japanese woman 69 years of age. She had been diagnosed as multibacillary leprosy with the positive results of slit-smear tests and the confirmation of the genomic sequence by PCR. Multidrug therapy had been started, but it was discontinued afterwards because an exact diagnosis of leprosy could not be determined by clinical, histological, and immunological assessment. As its diminishing prevalence in Japan, where ordinary physicians cannot have opportunities to see leprosy patients and they are unfamiliar with protean manifestations of the disease, it can be very difficult to make accurate diagnosis in those cases with atypical findings.

A 31-year-old man from Myanmar with leprous neuropathy was reported. The progress of the disease was subacute but the painful symptom at the time of the onset was acute. Multiple mononeuropathy was diagnosed by the biopsy findings of the left superficial radial nerve. He was admitted to our hospital with the complaint of the weakness of his left hand and fingers which were very painful and got worse in several weeks. Motor palsy was observed in his left ulnar, median, and radial nerves, and there was the hypesthesia or anesthesia in his left hand, forearm and the medial side of his left upper arm. On nerve conduction studies, the amplitudes of CMAP and SNAP severely diminished or not detected. The pattern was compatible with multiple mononeuropathy. The biopsy of the left superficial radial nerve was performed. The pathological findings were the destruction of nerve fascicles, replacement of nerve fibers with inflammatory cells, and Mycobacterium leprae was found with the specific stain. These findings confirmed the diagnosis of the leprous neuropathy. Leprous neuropathy is one of the commonest causes of infectious neuropathy in the world, especially in Southeast Asia. These days many foreign workers from that area are staying in Japan, and the chances to see the disease are increasing. We have to recognize leprous neuropathy as a candidate for the multiple mononeuropathy of acute onset with painful dysesthesia similar to vascular neuropathy.

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, was identified by G. H. A. Hansen in 1873. The different clinical presentations of the disease are determined by the quality of the host immune response. The bacteria have affinity for the peripheral nerves and are likely the cause of neuropathy, a cardinal manifestation of the disease. WHO recommends a protocol of multidrug therapy (MDT), which effectively controls the disease, hence contributing to the global elimination program. Early detection of leprosy and treatment by MDT are the most important steps in preventing deformity and disability.

We analyzed the medical and social problems of newly registered leprosy patients in the past 8 years from 1993 to 2000 in a low endemic country, Japan. There were 56 registered Japanese patients (males, 32; females, 24), and 76 registered foreign patients (males, 56; females, 20). The number of Japanese patients in each year was between 5 and 9, and 2/3 of them were from Okinawa Prefecture, located in subtropical zone. But the number of foreign patients in each year was between 5 and 18, and 2/5 of them were from Brazil. The number of foreign patients was greater than that of Japanese patients. Male/female ratio has decreased among the Japanese.

In Japan, a cautious definition of clinical cure of leprosy has been used since 1988. This report presents a new definition of clinical cure for leprosy patients after multi-drug treatment is completed. When the patients complete the standard treatment published in 2000, they are defined as "clinically cured". The doctor in charge should inform the patient of the cure of the disease clearly. On the release from the treatment, it is important to explain necessary cares for protection against injuries and prevention from deformities. The patient should be careful about signs of relapse and reactions.