Leprosy
Mailing List – October 18th, 2008
Ref.: Methaemoglobinaemia
and paralysis of the hemi-diaphragm
in a leprosy patient.
From:
Satheeka Kamaladasa
,
Sri Lanka
Dear Dr Noto,
Dr
Settinayake has kindly given me your e-mail address to discuss about
some complications in a patient with lepromatous leprosy.
A 35-year-old
patient was admitted to the ward with fever and a macular papular rash
of 3 days duration. He
was a diagnosed patient with lepromatous leprosy with multiple lesions
and had been treated with the multi-drug therapy for multibacillary
(MB) patients for 1 month duration.
While in the
ward he became dyspnoeic, cyanosed and the arterial blood
gases showed hypoxemia. Patient
was transferred to the ICU, and MB therapy was stopped suspecting a
dapsone hypersensitivity. Patient
was noticed to have mild icterus and the air entry on the R base of
the lung was reduced. Investigations
showed increased retic count, methaemoglobinaemia and
elevated liver enzymes.
Chest X-ray
showed elevated R hemidiaphgram with hardly any inflammatory
shadows. Ultra sound scan
showed reduced movement of the R hemidiaphgram. Awaiting Fluroscopy. At this stage diaphgramatic
paralysis due to involvement of the phrenic nerve was considered.
Whether this
could be explained by a leprosy reaction?
Or can you
put all these due to dapsone hypersensitivity syndrome?
Patient is on steroids
and anti leprosy therapy has been omitted. I would value expert opinion
about the explanation for his of respiratory problem. Whether it is related to a
leprosy reaction or its treatment?
Physians
& neurologists have seen the patient & have excluded other
pulmonary pathologies & nerological causes & cardiac causes.
Thanking.
Yours
sincerely,
Dr Satheeka
Kamaladasa
Consultant
Dermatologist
& Senior
Lecturer in Medicine
Dept Of
Medicine
Faculty of
Medicine
University
of
Sri Jayawardenapura
Sri
Lanka
