Borderline tuberculoid leprosy in 40-year-old male

Abstract

A 40-year-old Myanmar male presented with anesthetic hypopigmented lesions around the area of the left ear and at the back for 1 month. On physical examination, the consciousness was good. Skin examination revealed asymmetrical, multiple, discrete, well-defined, irregular, hypopigmented patches and infiltrated plaques on the left earlobe, left side of the face anterior to the left ear and right side of the back. His neurologic examination revealed decreased sensation on the skin lesions including the area of the skin which is supplied by a left facial nerve and great auricular nerve.

          Slit skin smear was taken by a dermatologist in the laboratory room. The result showed no acid fast bacilli found. Then the patient was performed a skin biopsy to confirm the diagnosis. The result was borderline tuberculoid (BT) leprosy. Thus the patient was diagnosed with BT leprosy. He was treated with oral rifampicin 600 mg per month and dapsone 100 mg per day for six months. At the six months follow up, the patient’s skin lesions became darker and the numbness was lessen. We then follow up the patient every six months for three years.

          Nowadays, the incidence of leprosy is low. Based on the latest data from the Ministry of Public Health in 2018, a prevalence rate of leprosy in Thailand was 0.05 case per 10,000 persons. To diagnose leprosy, the doctors need to take a history from the patients carefully. The skin and neurologic examination are also important. Leprosy can cause permanent damage and results in disability because of a misdiagnosis or a delay in the diagnosis, which adversely affects the quality of life of the patient.