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| FIGURE 1 | FIGURE 2 |
The physician suspected that the boy had lepromatous leprosy (FIGURES 1 and 2). His father was also examined and he exhibited more subtle signs of leprosy (several patches of hypopigmented skin with diminished sensation). The laboratory performed a slit skin exam on the boy’s ear lobe and many acid-fast bacilli--characteristic of Mycobacterium leprae--were found. The boy was started on the World Health Organization’s standard multidrug therapy using rifampin, clofazimine, and dapsone. The father was also treated.
Leprosy (Hansen’s disease) is caused by M leprae and is still endemic in many parts of the developing world where there is poverty and poor access to clean water. At one time, people with leprosy were isolated to leper colonies because the disease was disfiguring and the community was afraid that it was highly contagious. Current science and epidemiology tell us that leprosy is transmitted via droplets from the nose and mouth during close and frequent contact over a period of years, and not by casual contact. Thus doctors working with patients who have leprosy are at no real risk of becoming infected. In the United States, eating or handling armadillos is a risk factor for leprosy, as armadillos are natural hosts for M leprae.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Berggren R, Usatine R. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:53-79.
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