title: A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis.
abstract: We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed.
authors: USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar.
authors: Onivola
authors: 0000-0002-9226-952X
authors: O
authors: Raharolahy
authors: USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar.
authors: Lala S
authors: LS
authors: Ramarozatovo
authors: USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar.
authors: Irina M
authors: IM
authors: Ranaivo
authors: USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar.
authors: Fandresena A
authors: 0000-0003-2606-3539
authors: FA
authors: Sendrasoa
authors: USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar.
authors: Malalaniaina
authors: M
authors: Andrianarison
authors: Centre d'Infectiologie Charles Mérieux, Université d'Antananarivo, 101 Antananarivo, Madagascar.
authors: Mala Rakoto
authors: 0000-0001-6767-9554
authors: MR
authors: Andrianarivelo
authors: APHP, Hôpital Lariboisière, Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, 75475 Paris Cedex 10, France.
authors: Emmanuelle
authors: E
authors: Cambau
authors: USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, 101 Antananarivo, Madagascar.
authors: Fahafahantsoa Rapelanoro
authors: 0000-0002-0486-4071
authors: FR
authors: Rabenja