leprosy

 A 35 year old male patient resident of ramachandrapuram works as daily wage labourer who is a chronic smoker and alcoholic since 20 years 

He came to opd with history of painless lesions which were papules with erythematous base since 3 months which initially started over face and then extended to upper limb and lower limb and also trunk

patient previously got a topical cream soap and some oral drugs from a medical shop and used it for 2 months and few lesions regressed but some persisted on earlobe,hands and trunk

12 days back he developed blackish skin discolouration over hands and feet and there was cracking of skin and ulceration associated with burning sensation

since 1 week patient developed high grade fever associated with chills and rigor which was of  continuous type

no known co-morbidities present and no history of similar complaints in the past

on examination:

face:

madarosis-loss of eyebrows

depression of nasal bridge also called as saddle nose

skin of face and earlobe is thickened giving it leonine facies appearance

 

back:

presence of erythematous nodules and plaques

 

chest:

presence of variable hypopigmented patches

 

oral cavity:

palate is dark and erythematous

 

diagnosis:

lepromatous leprosy in type 2 reaction

investigations:

routine investigations are done

specifc investigations:

split skin smear(sss)

 

suggestive treatment:

treat the reaction along with multibacillary multidrug therapy

injectable steroids like prednisolone

supportive care