Initial diagnosis of leprosy in patients treated by an ophthalmologist and confirmation by conventional analysis and polymerase chain reaction.
OBJECTIVE
To report the initial diagnosis of leprosy in patients seeking treatment from an ophthalmologist in a tertiary eye care center, its confirmation by histopathologic and polymerase chain reaction analysis, and review of literature.


METHODS
Noncomparative retrospective case series.


METHODS
Patients with no known history of leprosy who were selected based on either a clinical suspicion or a histopathologic diagnosis and were found to have ocular or periocular lesions suggestive of leprosy.


METHODS
Review of clinical records of patients with no known history of leprosy seen by an ophthalmologist at a tertiary eye care referral center.


METHODS
Patient demographics, presenting symptoms and signs, diagnostic studies, complications, and treatment.


RESULTS
Among the 6 patients (5 women and 1 man; average age, 55 years), only 2 were found to have leprosy from clinical examination alone. Histopathologic characteristics or demonstration of acid-fast bacilli, suggestive of leprosy, were found in 5 patients. Definite confirmation of leprosy was made by polymerase chain reaction performed on formalin-fixed, paraffin-embedded tissues of 4 patients having suspected leprosy based on clinicohistopathologic examination results.


CONCLUSIONS
The diagnosis of leprosy relies on the clinical symptom complex, epidemiologic factors, and demonstration of acid-fast bacilli in the tissue sample. Considering that the global leprosy population is 12 million, a patient with leprosy may be found anywhere. The ophthalmologist may be the first one to encounter such patient, in which case suspicion and detection of ocular findings may lead to early treatment of the infection. Polymerase chain reaction may be a new tool in the definite diagnosis of leprosy when suspicion of the diseases is raised by clinicohistopathologic studies.
Chaudhry
Imtiaz A
IA
Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. orbitdr@hotmail.com
Shamsi
Farrukh A
FA
Elzaridi
Elsanusi
E
Awad
Abdulaziz
A
Al-Fraikh
Hamad
H
Al-Amry
Mohammed
M
Al-Dhibi
Hassan
H
Riley
Fenwick C
FC
D000328:Adult; D000368:Aged; D017931:DNA Primers / Q000737:chemistry; D004269:DNA, Bacterial / Q000032:analysis; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007917:Leprostatic Agents / Q000627:therapeutic use; D007918:Leprosy / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000235:genetics / Q000302:isolation & purification*; D009885:Ophthalmology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
D017931:DNA Primers; D004269:DNA, Bacterial; D007917:Leprostatic Agents