Methods: The Purified Protein Derivative (PPD) skin test may have some utility in the diagnosis of latent TB in the setting of paucibacillary leprosy, however “giant reactions” to PPD testing have been documented in monoinfection with multibacillary leprosy.
Results: A 32-year-old Marshallese woman presented to the surgical department with symptoms concerning for osteomyelitis of the 3rd distal phalanx, multiple burn wounds on both hands, and hypoaesthetic- hypopigmented skin lesions. She was referred to the National Hansen’s institute where a limited disarticulation of the distal phalanx and a slit skin biopsy was performed. Fite stain was negative, but PCR was positive for Mycobacterium leprae. The patient also had a strongly positive IGRA test for TB, and a positive PPD skin test. A chest x-ray showed a subtle infiltrate in the right middle lobe, three induced sputa were AFB negative by smear - however 1/3 was culture positive for drug-susceptible TB. The patient then underwent standard drug therapy for TB with the addition of dapsone for the treatment of Hanson’s. Repeat sputum cultures were negative at one month, and the patient had improvement in her skin hypopigmentation within four months of therapy.
Conclusion: The immunological milieu of the host appears to paradoxically influence susceptibility to mycobacterial coinfection, with no consensus regarding whether prior exposure to one offers protection or predisposition to the other. The clinical implications of failure to identify active TB in a case of leprosy can not be understated, and positive IGRA or PPD testing in leprosy should not be considered falsely positive without further investigation. If treatment for paucibacillary leprosy is to be considered before ruling out active TB then minocycline may temporarily replace Rifampin.
A. Jones, None
S. Movaghar, None
R. Kelly, None
D. Costic, None
See more of: Poster Abstract Session