Patient Case: Intermediate Leprosy (Indeterminate Leprosy)
A 27-year-old male school teacher from a rural region presents to a dermatology clinic with a single, well-defined, hypopigmented patch on his left upper arm. He reports that the lesion has been present for nearly a year but has not caused pain or itching. However, he recently noticed a slight loss of sensation over the patch.
On examination, the lesion is dry, with minimal scaling, and lacks hair growth. Light touch and temperature sensation over the area are mildly reduced, but no nerve thickening or deformities are noted. The rest of the neurological exam is unremarkable.
A slit-skin smear is negative for acid-fast bacilli, and a skin biopsy reveals sparse perineural lymphocytic infiltration with rare Mycobacterium leprae organisms. Given the findings, the patient is diagnosed with intermediate (indeterminate) leprosy, an early and potentially self-limiting form of the disease. He is started on a six-month course of dapsone and rifampicin to prevent progression to a more severe form. The patient is counseled on the importance of follow-up and monitoring for any signs of worsening disease.
- What is the most characteristic clinical feature of intermediate (indeterminate) leprosy?
A) Single hypopigmented lesion with mild sensory loss
B) Painful skin ulcer with purulent discharge
C) Multiple erythematous nodules with nerve thickening
D) Hyperpigmented patches with severe itching - Why is a slit-skin smear negative in intermediate leprosy?
A) The bacillary load is very low or absent
B) The patient is in the recovery phase of the disease
C) The test is only positive in viral skin infections
D) The biopsy sample was taken from an unaffected area - What is the primary goal of treating intermediate leprosy with dapsone and rifampicin?
A) To eradicate Mycobacterium leprae and prevent progression to more severe forms
B) To relieve pain and itching associated with the lesion
C) To improve cosmetic appearance of the lesion
D) To prevent respiratory complications from the disease - What is the most likely outcome of untreated intermediate leprosy?
A) Spontaneous resolution or progression to tuberculoid or lepromatous leprosy
B) Rapid spread of the lesions with systemic infection
C) Development of widespread necrotic ulcers
D) Formation of vesicles and bullae leading to scarring
