Delayed Diagnosis of Leprosy in a Patient with Pulmonary Tuberculosis: Lessons for Clinical Practice

Abstract

Introduction: Tuberculosis and leprosy are infections caused by the Mycobacterium sp. Both are significant health problems in Indonesia. Delayed diagnosis is still common in leprosy, causing disability.

Case Presentation: A 51-year-old with low socioeconomic status complained of cough, weight loss, and decreased appetite for more than a month. Anamnesis, physical examination, sputum, and Chest X-ray were consistent with pulmonary tuberculosis. The 10-month-old skin lesions became more inflamed one week after antituberculosis treatment. Dermatological examination revealed hyperesthetic lesions, enlargement of peripheral nerves, and negative Acid-Fast bacilli (AFB) results. He was diagnosed with multibacillary leprosy, type 1 reaction, grade 2 disability, and pulmonary tuberculosis. Treatment includes antituberculosis therapy, Multidrug Therapy, Multibasilar and corticosteroids.

Discussion: A complex relationship existed between socioeconomic factors, environment, nutritional status, access to health services, and the intricate host immune system in co-infection with Mycobacterium leprae and M. tuberculosis, which affected the occurrence of delays in our case. The host immune response to TB treatment likely triggered recognition of leprosy through an immune-modulatory mechanism, manifesting as a type 1 reaction. This complexity also presented a challenge in the diagnosis and treatment process, especially in developing countries.

Conclusions: This case illustrated the complexity of tuberculosis and leprosy infections, particularly in terms of risk factors, immune system interactions, and therapeutic interactions. Comprehensive management is important to prevent delays in diagnosis prevent complications such as disability, and reduce the risk of transmission of both diseases in the community.