A Young Female With Borderline Lepromatous Leprosy and Tuberculous Lymphadenitis: A Rare Coinfection

Abstract

In Bangladesh, tuberculosis and leprosy are endemic mycobacterial diseases; however, co-infection is rarely seen. Our patient had a high-grade fever, symmetrical polyarthritis, polymorphous erythematous lesions, widespread lymphadenopathy, peripheral neuropathy, bilaterally thickened ulnar nerves, and claw hands. A lymph node biopsy revealed tuberculosis having acid-fast bacilli with caseating epithelioid histiocytic granuloma. Cutaneous lesions and sural nerve biopsies indicated borderline lepromatous leprosy. Fite-Faraco stain showed the presence of lepra bacilli in the biopsied sural nerve. Mantoux test showed 15 mm induration in 72 hours. Nerve conduction study (NCS) showed severe sensory-motor polyneuropathy (axonal) of all four limbs. Prednisolone and thalidomide for severe type-2 lepra response and category-01 antituberculosis medication and multidrug therapy for multibacillary leprosy improved the patient's condition. Bacille Calmette-Guérin (BCG) vaccination in the community might protect against tuberculosis and leprosy, thus reducing such coinfection. However, reduced cell-mediated immunity might promote latent tuberculosis reactivation or super-infection in individuals with multi-bacilli illnesses.

Coinfection with Leprosy and Tuberculosis: A Case Series in Malagasy Patients

“…10 There is a worldwide decline in the number of co-infections of leprosy and tuberculosis in the modern era, which may be explained by the high prevalence of BCG vaccination coverage. 11 Mycobacterium leprae is a weakly acid-resistant bacillus that is unable to grow in vitro as an obligate intracellular pathogen, whereas Mycobacterium tuberculosis is a strongly acid-resistant bacillus and an extra or intracellular pathogen in macrophages that is cultivated in vitro. 12,13 Despite these specific characteristics, Mycobacterium leprae and Mycobacterium tuberculosis present more than 95% homology in amino acid sequences.…”

“…14 It is evidenced by the fact that BCG vaccination confers protection against leprosy and tuberculosis and by the conversion of lepromin intradermal tests after the administration of BCG. 11,14 Furthermore, positive Mantoux and QuantiFERON Gold tests and the presence of acidfast bacilli in sputum are misleading, as the sputum of patients with leprosy (mainly lepromatous leprosy) may stain positive for acid-fast bacilli, creating a diagnostic dilemma with sputum-positive pulmonary tuberculosis. 1,15 Therefore, chest X-ray evidence of active tuberculosis and positive tuberculosis cultures are the gold standard for the diagnosis of active tuberculosis infection in a patient with leprosy.…”