title: Lepromatous leprosy in a kidney transplant recipient: a case report.
abstract: Leprosy is a chronic granulomatous disease of the skin and peripheral nerves caused by Mycobacterium leprae. Among mycobacterial infections, leprosy is rare in renal transplant recipients. Here, we report the manifestations of lepromatous leprosy in a 41-year-old renal transplant recipient. Before the renal transplant, the patient had recurrent bullous lesions on his extremities with no systemic complaints. He was on an immunosuppressive regimen that included prednisolone (1 mg/kg/d), cyclosporine (6 mg/kg), and mycophenolate mofetil (2000 mg/d), and had 2 serologically confirmed acute episodes of cytomegalovirus infection that responded favorably to intravenous ganciclovir. The density of his bullous skin lesions decreased after renal transplant. During his regular posttransplant visits, we noticed a decrease in his eyebrow hairs on their lateral margins bilaterally. Later, he developed generalized, symmetric, erythematous papules. With a positive acid-fast bacilli with Fite staining, the results of a skin biopsy showed diffuse foamy histiocyte infiltration in the dermis. These findings are compatible with lepromatous leprosy. After antileprosy therapy, no deterioration of renal allograft function or lepra reactions was noted in a 4-month follow-up. Clinicians should consider leprosy in the differential diagnosis of skin lesions in immunocompromised hosts, and in particular, solid organ transplant recipients in endemic areas.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Tabriz University of Medical Sciences, Tabriz, Iran. ardalan34@yahoo.com
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Ardalan
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghaffari
authors.forename: Kamyar
authors.initials: K
authors.lastname: Ghabili
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007917:Leprostatic Agents / Q000627:therapeutic use; D015440:Leprosy, Lepromatous / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D008297:Male; D009166:Mycobacterium leprae / Q000302:isolation & purification*; D012867:Skin / Q000187:drug effects / Q000382:microbiology* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D007917:Leprostatic Agents