Leprosy
Mailing List – November 5thr, 2010
Ref.: Case
presentation
From:
Tamang Krishna,
Dhanusa
,
Nepal
Dear
Dr Noto,
I
am Dr. Krishna working at
Lalgadh Hospital
,
Nepal
. About 2 months ago we
diagnosed a 52 years male with multibacillary (MB)
leprosy. On diagnosis he
was presenting with diffuse infiltration on face and type two
reaction. We screened
for diabetes and hypertension before starting prednisolone.
We started MB multi-drug
therapy (MDT) and prednisolone with standard protocol with 40mg 2
weeks and taper down 30mg.
He
was complaining headache and faintness. We
admitted him for screening; his blood sugar was high
about 250 mg. He was sent
home with oral hypoglycaemic drug (glibencamide 5 mg once daily) again after
two days he complained sudden loss of vision in his left eye with
ptosis. We immediately referred to ophthalmologists who
diagnosed central retinal artery occlusion. He was again taken to
physician and started human insulin and admitted in hospital
about 10 days. At this point, during the course of
treatment he developed ulcer on the soft palate and get
perforated. They did
biopsy and found fungus.
This
is my bitter experience. The
patient deteriorated very fast; ct scan of head was done and
every thing was normal. Now he is on MB-MDT and oral
hypoglycaemic drug. His blood sugar is under
control, but he has perforation of palate. He
severe difficulty in drinking and eating; it will regurgitate
from nose.
Could
you please comment? Have
anyone faced such problem?
Thank
you,
Dr.
Krishna Bdr Tamang (lama)
Lalgadh
Hospital
Dhanusa
Nepal
