Patient Case: Tuberculoid Leprosy
A 40-year-old male carpenter from a rural region presents to a dermatology clinic with a complaint of multiple discolored patches on his right forearm and upper back. He reports that these patches have been present for over a year and have gradually expanded. He does not experience pain or itching but has noticed numbness over the affected areas.
On examination, there are two well-demarcated, hypopigmented, and anesthetic patches with dry, scaly skin. The edges of the lesions are slightly raised, and there is thickening of the right ulnar nerve, with weakness in his hand grip. No nodules or widespread skin involvement is observed. A slit-skin smear is negative for acid-fast bacilli, but a skin biopsy shows granulomatous inflammation with few bacilli, confirming tuberculoid leprosy.
The patient is started on multidrug therapy (MDT) with rifampicin and dapsone for six months. He is counseled about the importance of adherence to treatment and nerve function monitoring to prevent permanent disability. Contact tracing is also initiated to screen close family members for leprosy.
- What is the most characteristic clinical feature of tuberculoid leprosy?
A) Hypopigmented patches with loss of sensation
B) Multiple nodules and diffuse skin thickening
C) Blistering rash with severe itching
D) Widespread ulcers with necrotic tissue - Which nerve is most commonly involved in tuberculoid leprosy, often leading to hand weakness?
A) Ulnar nerve
B) Sciatic nerve
C) Phrenic nerve
D) Optic nerve - Why was the slit-skin smear negative in this patient?
A) Tuberculoid leprosy has a low bacterial load
B) The sample was taken from an unaffected area
C) The patient had already received partial treatment
D) The test only detects viral infections - What is the primary treatment regimen for tuberculoid leprosy?
A) Rifampicin and dapsone for 6 months
B) Isoniazid and rifampicin for 9 months
C) Amphotericin B and fluconazole for 12 months
D) Doxycycline and azithromycin for 3 months
