Leprosy
Mailing List, April 30th, 2009
Ref.: Itching
in leprosy
From: Manimozhi
N.,
Bangalore
,
India
Dear
Dr. Salvatore Noto,
This
is with reference to Dr Pai’s Leprosy Mailing List, April 25th,
2009, Pruritus in BL, LL and smear positive relapse leprosy lesions.
During
my tenure at SLR&TC – Department of Epidemiology and leprosy
control from 1985 through 2001, we had come across instances where
patients reported with pruritus as the main complaint and diagnosis of
reactions and relapse was made after examination. It
was noted that it was actually – parasthesia (abnormal sensation)
which the patients expressed it to as itching (pruritus) in their own
local language and some did mention as burning sensation as well.
Brief
case study: Mono- therapy Relapse case presenting with pruritus/rashes
as main complaint.
An
elderly Anglo-Indian (Mr. Hawkinns – name changed) inmate of
Cheshire Home at Virudampet /Vellore, Tamil Nadu, India aged more than
70 years, a know case of Lepromatous leprosy released from treatment.
He had an interesting history of treatment started with Hydnocarpus
oil injections and Dapsone. He
used to attend the outreach village clinics conducted within the
Cheshire Home campus for general complaints along with others. All
the inmates had a separate released from control (RFC) register
maintained in which all clinical, treatment details where documented.
It
was around 1992 to 1995, there was an anniversary celebrations of
Cheshire
at
UK
for which Mr. Hawkinns was invited to attend the function. The
British Airways wanted a certification of fitness and not infectious
to others from a specialized institution. He
was very carefully screened by 2 senior specialist and me as well,
skin smear examination carried out which was negative and he was
declared to be sign free. Mr.
Hawkinns visited
UK
, and he could meet all his cousins there spent about more than a
month and returned back. And
during our clinic day at the Cheshire Home centre he attended the
clinic looking very cheerful, happy but with some complaints of rashes
associated with itching, while on examination few micro-papular
lesions and plaques where noticed and a skin smear examination was
carried out and was positive with BI more than 2+, which ultimately
turned out to be a relapse. Multi-drug
therapy MB was initiated and after few months our good friend passed
away due to some other general illness. I
am sure Mr. Hawkinns case card is well preserved in the records
department (deleted as Expired) to verify in case accurate and or more
details is needed.
Lesson
learnt from this episode is :
Leprosy
is indeed a great imitator.
Presentation
of complaints in patients own terminology may be misleading.
Routine
sites can show skin smear negativity – While lesions in relapse
cases can occur in rare sites which could show skin smear positivity.
It
may take a short duration of time (2-3 months in this case) for the
disease to express signs of relapse after the last
clinical/bacteriological examination.
Dr.
N. Manimozhi
Medical
Coordination- AIFO
Bangalore,
India
