Thursday, July 17, 2008

Leprosy (Hansen's Disease)




Examine this patient's feet

Look at this patient's face and examine him

You might this case in Malaysia PACES center, station 5.

This patient has leonine facies (face features resemble a lion) and the ear lobe is thickened as well.

Note: The other differential for leonine facies is cutaneous T cell lymphoma.

There is presence of amputated R index finger and L 4th and 5th toe. The small muscles of the hands are wasted.

There is evidence of sensory peripheral neuropathy and the ulnar and common peroneal nerves are thickened on palpation.

The overall picture shows that this patient has lepromatous leprosy complicated by severe neuropathy.

Questions:

1) How would you classify leprosy ?

According to Madrid classification system, it is classified into Tuberculoid, Bordeline and Lepromatous type.

However, WHO classify it into 2 types i.e. paucibacillary and multibacillary type for treatment purposes.

2) How would you investigate this patient ?

- Slit skin smear, skin biopsy

- Nerve conduction study for neuropathy as in this patient

3) How would you manage this patient ?

Start anti Leprosy agents - Clofazamine, Dapsone, Rifampicin

Screen other family members

2 comments:

Harry TEOH said...

study purposes, does hansen disease patient come for final year medical student examination?

Wuchereria said...

Possible, it's under skin. so not as common for final year medical students - concentration still on abdomen, CVS, respi and neurology. Also depends on your university. It's good to know though..