Localized lepromatous leprosy and its response to chemo-immunotherapy.
BACKGROUND
This is an unusual presentation of lepromatous leprosy (LL) in a young boy, 12 years of age. The study forms part of a large scale immunotherapeutic trial with Mycobacterium w (M.w) antileprosy vaccine. The trial is being conducted in two major hospitals in New Delhi, India.


METHODS
This patient presented with three lesions: one on each forearm and the third on the left leg. He was classified initially as borderline tuberculoid leprosy. Slit-skin smears and histopathology from the lesions proved the diagnosis to be lepromatous leprosy with a bacterial index (BI) 6+. The initial lepromin test was negative. The patient was treated with chemo-immunotherapy (standard multidrug therapy and immunotherapy with Mycobacterium w vaccine).


RESULTS
Investigations after 1 year (15 months) of multi-drug therapy and three doses of vaccine, showed a remarkable fall in the BI from 6 to 0 in the lesions, a lepromin positivity of 5 mm, and a histological upgrading from lepromatous leprosy to borderline tuberculoid. Immunologic studies at 15 months revealed a good LTT response and high levels of cytokines, specifically IL-2 and IFN-gamma.


CONCLUSIONS
This report presents an LL patient with disease limited to a few sites. It stresses the importance of slit-smear and biopsy in all patients of leprosy, and it highlights the upgrading observed on administration of chemo-immunotherapy.
Beena
K R
KR
National Institute of Immunology, New Delhi, India.
Zaheer
S A
SA
Guleria
I
I
Mukherjee
R
R
Talwar
G P
GP
Mukherjee
A
A
Ramesh
V
V
Misra
R S
RS
D001428:Bacterial Vaccines / Q000008:administration & dosage*; D002648:Child; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D006801:Humans; D007917:Leprostatic Agents / Q000008:administration & dosage*; D015440:Leprosy, Lepromatous / Q000473:pathology* / Q000628:therapy; D008297:Male
D001428:Bacterial Vaccines; D007917:Leprostatic Agents; C060596:anti-leprosy vaccine