Case Report

Multibacillary Leprosy

Presented by: Juliah Makdasari

Supervisor: dr. Irma Tarida L, Sp.KK

Department of Dermatology and Venereology

Mardi Waluyo Public Hospital, Blitar
Faculty of Medicine, University of Islam Malang
2018
IDENTITY
 Name : Mr. N
 Age : 33 years old
 Sex : Male
 Adress : Blitar
 Job : Farmer
 Religion : Islam
 Marriage Status : Married
 Examination Date: October 8th, 2018
HISTORY
Chief Complaint

• Pale patches over various part of his body

History of present illness

• The patient came with pale patches on his chest,

back, both arms and legs since 5 years ago. The
lesions were non-pruritic and unpainful. He also
complained about a partial loss of sensation and
tingling on his arms and legs.
Past Medical History

• No past medical history of dermatology disease

• Denied any systemic disease.

Family History

• History of contact with leprosy patients was

confirmed, and his brother has a similar sickness.
 Medical History

• This patient has not been treated

Allergy

• No allergy history of drugs and food

Physical Examination
 General Condition
Good condition
 Consciousness
Compos mentis, GCS 4 5 6
 Vital Sign
Pulse : 90 x/menit,
RR : 20 x/menit,
Tax : not performed
Physical Examination

 Head to Toe
1. Eyes : normal
2. Thorax : cor dan pulmo normal
3. Abdomen : soefl, bowel sounds (+), timpanyc,
tenderness (-)
4. Extremities : swelling extremities (-/-)
Physical Examination
 Dermatology status

Chest, back, both arms and legs area :

Hypopigmented, hairless, dry skin lesions with definite loss
of sensation
 The lesions were accompanied with thickening of
bilateral great auricular nerves, bilateral ulnar nerves,
and bilateral lateral peroneal nerves
 Atrophy of left thenar muscles and dorsal interosseus
muscles
Slit skin smears
(Ziehl-Neelsen stain)

acid-fast bacilli : 1 (+)

Differential Diagnosis

• Pausibacillary leprosy
• Tinea versicolor

Diagnosis

• Multibacillary leprosy
PLANNING TREATMENT

Therapy

• MDT regimen (12 months)

• Rifampicin 600 mg (once a month)
• Clofazimine 300 mg (once a month), 50 mg daily
• Dapsone 100 mg daily
• Neurodex (twice daily)
Education
• Take medicines daily for the scheduled
period of treatment
• Detect early symptoms of leprosy in the
patient’s family
• Ask the patient to wear proper shoes and
gloves while working

Follow up

• Evaluation of lesion and chief complaint

 Case
• His brother has a similar
sickness
• Hypopigmented lesions with
definite loss sensations on the
chest, back, both arms and
legs area
Theory
• Risk factor: blood relative with
leprosy
• 3 cardinal signs of leprosy:
 Hypopigmented or
erythematous skin lesions
with definite loss
/impairment of sensations.
 Case
 Partial loss of sensation and
tingling on his arms and legs
• Thickening of bilateral great
auricular nerves, bilateral ulnar
nerves, and lateral peroneal nerves
• Atrophy of left thenar muscles and
dorsal interosseus muscles
Theory
 Involvement of the peripheral
nerves as demonstrated by
definite thickening with sensory
impairment.
 Case
• Ziehl-Neelsen showed acid-
fast bacilli (AFB) with
bacteriological index (BI) of 1+
• More than five skin lesions
Theory
 Skin smear positive for AFB
 Multibacillary leprosy:
>5 lesions, >1 nerve involved
Differential Diagnosis

• Tinea versicolor
• Hypopigmented lesions, no loss of sensation,
no enlargement of peripheral nerves, AFB (-)

• Paucibacillary leprosy
• <5 lesions, only 1 nerve involved, AFB (-)
Conclusion

 Based on history, physical examination, and

supporting examinations, the patient was
diagnosed with multibacillary leprosy.
 Multibacillary leprosy treated with multiple drug
therapy for 1 year.
THANK YOU