Patient Case: Hansen’s Disease (Leprosy)
A 35-year-old male construction worker from a remote rural region presents to a local health clinic with multiple skin lesions that have progressively worsened over the past two years. He reports numbness in his hands and feet, along with weakness in his right hand that has made it difficult to grip tools. He denies fever or weight loss but mentions that his skin lesions do not itch or hurt.
On examination, there are hypopigmented, anesthetic patches with dry, scaly skin on his arms and back. His ulnar nerve is thickened and tender, and there is mild clawing of his right hand. A skin smear and biopsy confirm the presence of Mycobacterium leprae.
The patient is diagnosed with borderline tuberculoid leprosy and started on multidrug therapy (MDT) consisting of rifampicin, dapsone, and clofazimine. He is counseled on the importance of adherence to treatment to prevent progression and disability, as well as the need for contact screening to identify other possible cases in his household.
- Which clinical feature is most suggestive of leprosy (Hansen’s disease) in this patient?
A) Painful skin lesions with itching
B) Hypopigmented patches with loss of sensation
C) Multiple fluid-filled blisters
D) Vesicular rash following a dermatomal pattern - Which nerve is most commonly involved in leprosy leading to hand deformities?
A) Sciatic nerve
B) Ulnar nerve
C) Phrenic nerve
D) Radial nerve - What is the first-line treatment for borderline tuberculoid leprosy?
A) Isoniazid and rifampicin
B) Multidrug therapy with rifampicin, dapsone, and clofazimine
C) Metronidazole and azithromycin
D) Amphotericin B - Why is early treatment crucial in leprosy management?
A) To reduce the risk of respiratory complications
B) To prevent progression to multi-bacillary leprosy and nerve damage
C) To decrease the likelihood of secondary bacterial infections
D) To eliminate the risk of gastrointestinal complications
