Leprosy in Nepal: a re-emerging threat

One Case of Tuberculosis-Like Leprosy with a Type I Leprosy Reaction

Leprosy is a chronic infectious disease primarily affecting the skin and peripheral nerves and is caused by Mycobacterium leprae. Although effective control measures have significantly reduced its global incidence in recent years, its insidious onset and diverse skin manifestations pose considerable challenges to early diagnosis, particularly among young medical practitioners. This study reports a case of tuberculoid leprosy accompanied by a type I reaction (T1R) to leprosy, aiming to contribute to the broader understanding and management of the disease. The patient came from a leprosy-endemic region and had a family history of leprosy. They first presented with neuritis, characterised by numbness in the left upper limb, which is an early-stage symptom often overlooked. This case accentuates the importance of comprehensive examination techniques, including bacteriological and histological investigations, ultrasound and magnetic resonance imaging, to identify early nerve damage, which is critical for prompt diagnosis and intervention. According to World Health Organization data, approximately 200,000 new cases of leprosy are reported worldwide each year, with a prevalence rate of 0.2 cases per 10,000 individuals. The disease exhibits two clinical forms based on the host's immune response: tuberculoid leprosy in a well-immunised population and lepromatous leprosy in a poorly immunised host. The patient in this study demonstrated signs of tuberculoid leprosy, marked by isolated skin papules and plaques, and a T1R, a tissue-destructive, immune-driven inflammatory process. This case underscores the need for ongoing education and updated diagnostic tools to facilitate the early detection of leprosy, particularly in endemic areas. Moreover, attention must be given to the comprehensive care of patients, encompassing both physical and psychological aspects, to improve their quality of life and mitigate social discrimination and prejudice.

Borderline tuberculoid leprosy misdiagnosed as Cheilitis Granulomatosa Miescher: A case report

Macrocheilia, as an initial manifestation of leprosy, is uncommon. We present a case of a 50‐year‐old female, with lower lip swelling, initially diagnosed as Cheilitis Granulomatosa Miescher. Unresponsiveness to local intralesional corticosteroids necessitated further evaluation. Repeat tissue sampling yielded a confirmatory diagnosis of borderline tuberculoid leprosy, which was managed successfully.