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Hansen Disease (Leprosy)

      A 77-year-old man with psoriatic arthritis, on methotrexate, presented with asymptomatic skin lesions. He denied altered sensation within the lesions and history of international travel, but he reported previously cleaning out suspected armadillo burrows. Physical examination revealed pink, smooth, annular, and cyclic papules and plaques on the extremities and back (Figures 1 and 2). Histopathology showed clusters of acid-fast staining organisms within foamy histiocytes in the dermis (Supplemental Figure, available online at http://www.mayoclinicproceedings.org). Tissue polymerase chain reaction was positive for Mycobacterium leprae, confirming the diagnosis of Hansen disease. Based on clinical and histopathological findings, the patient was classified as having borderline lepromatous disease. Treatment for multibacillary disease with clofazimine, dapsone, and rifampin was initiated for a planned 24-month course, with near resolution of skin lesions after 6 weeks.
      Figure thumbnail gr1
      Figure 1Annular and cyclic pink papules and plaques on the thigh.
      Figure thumbnail gr2
      Figure 2Annular pink plaque on the lower back.
      Hansen disease, or leprosy, is caused by infection with Mycobacterium leprae, an acid-fast staining, obligate intracellular organism.
      • Maymone M.B.C.
      • Laughter M.
      • Venkatesh S.
      • et al.
      Leprosy: clinical aspects and diagnostic techniques.
      Most cases are seen in India, Brazil, and Indonesia, although the nine-banded armadillo is a zoonotic reservoir for M. leprae in the United States.
      • Maymone M.B.C.
      • Laughter M.
      • Venkatesh S.
      • et al.
      Leprosy: clinical aspects and diagnostic techniques.
      ,
      World Health Organization
      Global leprosy update, 2018: moving towards a leprosy free world.
      Risk factors for infection demonstrated in our case include age above 50, exposure to armadillos, and immunosuppressed status.
      • Maymone M.B.C.
      • Laughter M.
      • Venkatesh S.
      • et al.
      Leprosy: clinical aspects and diagnostic techniques.
      ,
      • Teixeira C.S.S.
      • Pescarini J.M.
      • Silva R. de CR.
      Incidence of and factors associated with leprosy among household contacts of patients with leprosy in Brazil.
      ,
      • Trindade M.A.
      • Palermo M.L.
      • Pagliari C.
      • et al.
      Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature.
      Hansen disease classically presents with cutaneous and neurologic findings ranging from solitary or few annular plaques with lesional anesthesia to diffuse macules, papules, and skin infiltration with stocking-glove neuropathy.
      • Maymone M.B.C.
      • Laughter M.
      • Venkatesh S.
      • et al.
      Leprosy: clinical aspects and diagnostic techniques.
      Disease can be categorized along a polar spectrum ranging from tuberculoid to lepromatous disease, using the Ridley and Jopling classification system.
      • Maymone M.B.C.
      • Laughter M.
      • Venkatesh S.
      • et al.
      Leprosy: clinical aspects and diagnostic techniques.
      Treatment is with rifampin and dapsone +/– clofazimine for 6 to 24 months, depending on whether the disease is paucibacillary or multibacillary.
      Health Resources and Services Administration
      NHDP Guide to the Management of Hansen’s Disease.
      ,
      World Health Organization, Regional Office for South-East Asia
      Guidelines for the diagnosis, treatment and prevention of leprosy.

      Supplemental Online Material

      Figure thumbnail figs1
      Supplemental FigureClusters of acid-fast staining organisms (arrow) within foamy histiocytes.

      References

        • Maymone M.B.C.
        • Laughter M.
        • Venkatesh S.
        • et al.
        Leprosy: clinical aspects and diagnostic techniques.
        J Am Acad Dermatol. 2020; 83: 1-14
        • World Health Organization
        Global leprosy update, 2018: moving towards a leprosy free world.
        Wkly Epidemiol Rec. 2019; 94: 389-411
        • Teixeira C.S.S.
        • Pescarini J.M.
        • Silva R. de CR.
        Incidence of and factors associated with leprosy among household contacts of patients with leprosy in Brazil.
        JAMA Dermatol. 2020; 156: 1-10
        • Trindade M.A.
        • Palermo M.L.
        • Pagliari C.
        • et al.
        Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature.
        Transpl Infect Dis. 2011; 13: 63-69
        • Health Resources and Services Administration
        NHDP Guide to the Management of Hansen’s Disease.
        (Available at:) (Accessed October 3, 2020)
        • World Health Organization, Regional Office for South-East Asia
        Guidelines for the diagnosis, treatment and prevention of leprosy.
        World Health Organization, Institutional Repository for Information Sharing, 2018