Challenges in Managing a Lepromatous Leprosy Patient Complicated with Melioidosis Infection, Dapsone-Induced Methemoglobinemia, Hemolytic Anemia, and Lepra Reaction

Abstract

Patient: Female, 22-year-old Final Diagnosis: Lepromatous leprosy co-infected with melioidosis • complicated by dapsone-induced methaemoglobinaemia and type 2 lepra reaction Symptoms: Cyanosis • fever • jaundice • pallor • skin rash Medication: — Clinical Procedure: — Specialty: Dermatology • Hematology • Infectious Diseases • General and Internal Medicine • Microbiology and Virology Objective: Unusual clinical course Background: Leprosy is an infection caused by Mycobacterium leprae . An extensive literature search did not reveal many reports of melioidosis in association with leprosy. Case Report: A 22-year-old woman, who was diagnosed with multibacillary leprosy, developed dapsone-induced methemoglobinemia and hemolytic anemia, complicated by melioidosis. Methemoglobinemia was treated with methylene blue and vitamin C. Two weeks of ceftazidime was initiated to treat melioidosis, and the patient was discharged on amoxicillin/clavulanic acid and doxycycline as melioidosis eradication therapy. However, she developed drug-induced hypersensitivity. Trimethoprim/sulfamethoxazole, as an alternative treatment for melioidosis eradication, was commenced and was successfully completed for 12 weeks. During the fifth month of multidrug therapy, the patient developed type II lepra reaction with erythema nodosum leprosum reaction, which was treated with prednisolone. Leprosy treatment continued with clofazimine and ofloxacin, and complete resolution of skin lesions occurred after 12 months of therapy. Conclusions: Our case highlighted the challenges posed in managing a patient with multibacillary leprosy with multiple complications. Clinicians should be aware that dapsone-induced methemoglobinemia and hemolysis might complicate the treatment of leprosy. Our case also highlighted the safety and efficacy of combining ofloxacin and clofazimine as a leprosy treatment regimen in addition to gradual steroid dose titration in the presence of type II lepra reaction.

Mycobacterium leprae and host immune transcriptomic signatures for reactional states in leprosy

“…In addition, we noted that 10 virulence genes were significantly over expressed. They are ML0243—Putative acyl-CoA synthetase, ML1014—RNA polymerase sigma factor sigB, ML1076—RNA polymerase sigma factor SigE, ML1128—Diaminopimelate decarboxylase, ML1633—Possible secreted hydrolase, ML1727—O-phosphoserine phosphohydrolase( Acebrón-García-de-Eulate et al, 2021 ), ML1925—Superoxide dismutase [Cu-Zn], ML1954—Pantothenate kinase( Hasan et al, 2004 ), ML2307—Transcriptional regulator and ML2439—Sensory transduction protein RegX3 ( Duthie et al, 2007 ; Sapkota et al, 2010 ; Tang et al, 2021 ).…”

Leprosy Classification, Clinical Features, Epidemiology, and Host Immunological Responses: Failure of Eradication in 2023

“…AFBs are highly positive. The lesions of LL are numerous with bilateral symmetry over the face, extremities, and trunk [ 58 ]. Lesions may present in any of the stages.…”

Severe anemia on the treatment of a Lepra patient with a history of long-term steroid consumption suspect of Cushing syndrome

“…Dapsone (4, 4-diamino-diphenyl sulfone) is a sulfonamide group that is slowly but almost completely absorbed from the gastrointestinal tract, and its central metabolism occurs in the liver (Vinod, Arun, & Dutta, 2013). Methemoglobinemia generally occurs when dapsone is administered at a dose of 200-300 mg/day, and severe methemoglobinemia results from a genetic disorder with deficiency of the enzyme NADH-dependent methemoglobin reductase (Kusumastanto, 2015;Muhaira et al, 2018;Tang et al, 2021). On laboratory examination, it was found that the Hb level was very low when the patient came with shortness of breath in the emergency room.…”