Leprosy & gangrene: a rare association; role of anti phospholipid antibodies.
BACKGROUND
Leprosy still remains an important public health problem for many parts of the world. An association of gangrene with leprosy is a rare one & can have a number of causative mechanisms. We present a case with Leprosy & gangrene with positive anti phopholipid antibody titers.


METHODS
A 50-year-old non-diabetic, non-hypertensive lady presented with 2 months history of progressive gangrene of bilateral toes. She was found to have madarosis & hypopigmented, hypoaesthetic macular lesions on the upper limb & thighs. Bilateral ulnar & popliteal nerves were thickened. A skin biopsy of the lesions revealed borderline tuberculoid leprosy, slit skin smears revealed a bacteriological index of 1+. She did not have any evidence of thromboembolic episode or atherosclerosis. ACLA was positive at presentation & also on another occasion 6 weeks later. ACLAs were of the IgM type on both occasions. Lupus Anticoagulant & beta2 GPI antibody were negative. DOPPLER of the lower limb arteries did not reveal any abnormality. Patient was successfully treated with multi-drug antileprotics & anticoagulants.


CONCLUSIONS
Infectious APLAs should be recognized as a cause of thrombosis in Leprosy. Appropriate anticoagulation can salvage limb function.
Akerkar
Shashank M
SM
Dept of Medicine, Seth GSMC & KEM Hospital, Parel, Mumbai, 400012, India. shashank77_2000@yahoo.com
Bichile
Lata S
LS
D017152:Antibodies, Antiphospholipid / Q000097:blood / Q000276:immunology*; D005260:Female; D005734:Gangrene / Q000150:complications / Q000209:etiology*; D006801:Humans; D015441:Leprosy, Tuberculoid / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged
D017152:Antibodies, Antiphospholipid