title: Leprosy-like illness in a patient with Mycobacterium lepromatosis from Ontario, Canada.
abstract: Here we present the first case of a patient from Ottawa Canada, presenting with leprosy-like illness associated with Mycobacterium lepromatosis. The patient had no history of travel to leprosy-endemic areas or any obvious risk factors. Clinically, the patient presented with an anesthetic maculopapular rash on the trunk, back, and extremities. A skin biopsy of a lesion revealed a dermal lymphohistiocytic infiltration involving the vessels with an inflammatory process extending to the nerves. A neurological exam also identified a severe sensorimotor polyneuropathy. Concurrently, the patient was diagnosed with non-resectable, non small cell carcinoma of the lung, further complicating his clinical presentation. A Kinyoun stain of nasal blows and a Fite stain of the skin biopsy revealed few to moderate acid fast bacilli respectively. Cultures of the skin biopsy and multiple nasal blows were negative. Molecular studies of a skin biopsy sample including sequence analysis of a 765 bp region of the 16s rRNA gene eventually identified the organism with 100% homology to M. lepromatosis. The patient was treated for leprosy and appeared to improve slightly on therapy but died as a result of his malignancy approximately five months after the initiation of therapy. This represents the first case of a patient with M. lepromatosis like illness outside of Mexico and Singapore.
authors.affiliation: The Ottawa Hospital and The Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Jessamine
authors.forename: Marc
authors.initials: M
authors.lastname: Desjardins
authors.forename: Tom
authors.initials: T
authors.lastname: Gillis
authors.forename: David
authors.initials: D
authors.lastname: Scollard
authors.forename: Frances
authors.initials: F
authors.lastname: Jamieson
authors.forename: George
authors.initials: G
authors.lastname: Broukhanski
authors.forename: Pam
authors.initials: P
authors.lastname: Chedore
authors.forename: Anne
authors.initials: A
authors.lastname: McCarthy
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D015440:Leprosy, Lepromatous / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D009166:Mycobacterium leprae / Q000302:isolation & purification*; D009864:Ontario
chemical_list: D000900:Anti-Bacterial Agents