Lepromatous leprosy: consequences of a neglected disease - a case report

Abstract

INTRODUCTION: Leprosy is a chronic infection caused by Mycobacterium leprae that affects the skin and peripheral nerves and may involve the eyes, bones, and mucous membranes. The lepromatous form is characterized by diffuse tissue infiltration, leading to severe sequelae such as leonine facies and functional impairment. Despite the global reduction in disease burden, Brazil still has high leprosy rates and many late diagnoses. Treatment consists of multidrug therapy (MDT) with rifampicin, dapsone, and clofazimine and is essential to prevent complications. Early detection is critical. CASE REPORT: A 74-year-old man born in Ceará and living in São Bernardo do Campo was referred to dermatology after multiple hospitalizations and investigations for infectious and rheumatologic diseases without a conclusive diagnosis. He reported weakness, right-arm edema, and difficulty walking, with progressive worsening over five years. During the most recent hospitalization, he developed ulcerated nodules, blisters, and fever, initially raising suspicion of thrombosis and bacterial infection. Examination showed madarosis, facial infiltration, limb edema, hand and foot deformities, and diffuse hypoesthesia. Biopsy and slit-skin smear confirmed multibacillary lepromatous leprosy with a type 2 leprosy reaction. Oral corticosteroids and multibacillary MDT were initiated, with clinical improvement. DISCUSSION: Leprosy diagnosis is essentially clinical and epidemiologic. Despite its declining global burden, Brazil continues to have high rates of late diagnosis, which worsens prognosis and quality of life. Underdiagnosis is related to insufficient training among healthcare professionals and low public awareness. This case illustrates the difficulty of early disease recognition, which resulted in multiple hospitalizations and inappropriate treatments. Early detection prevents complications, reduces transmission, and improves treatment and patients’ quality of life.