Incidentally Discovered Relapse of Leprosy in a Burned Patient with 30 Years after Completion of Therapy

30年前已治癒之痲瘋病復發於燙傷病人－案例報告

張簡志炫(Chih-Hsuan Changchien)

《臺灣整形外科醫學會雜誌》 19卷1期 (2010/03) Pp. 72-77

https://doi.org/10.7096/TJTSPS.201003.0072

摘要

背景：
痲瘋病(leprosy)又名漢生症(Hansen' disease)，是一種侵犯皮膚及週邊神經之古老疾病，由痲瘋桿菌(Mycobacterium leprae)所引起，在已開發國家極為少見，年輕臨床醫師對此疾病尤其陌生。隨著日漸增加的國際交流及外籍勞工的引進，漢生症有可能在任何地方出現。
目的及目標：
由於此症臨床皮膚表徵極為多樣性，臨床診斷有其難度，病史與組織切片為早期診斷與治療的重要依據。透過這篇案例報告，期盼重新喚起臨床醫師的注意。
材料及方法：
本篇報告一位三十年前已完成治療結案之漢生病患者，在治療燙傷不癒引發之足底潰瘍期間，同時診斷漢生症復發，並另以腹部多形性紅疹表現。
結果：
經過即時適當藥物控制與植皮手術重建足底潰瘍，病患癒後良好。
結論：
以植皮手術重建漢生病患足底潰瘍，經一年追蹤病患，癒後良好。值得注意的是即使已完成藥物治療結案之漢生病患者，漢生病仍然有可能復發。透過早期診斷與長期監控藥物治療，可以減少皮膚神經病變引發之後遺症，同時達到公衛防治目的。

並列摘要

Background:
Leprosy is rare in developed countries and many physicians are unfamiliar with this disease. With the increase in international travel, employment of foreign workers, and immigration from regions in which leprosy is endemic, leprosy can be found anywhere. Aim and Objectives:
Physicians are likely to encounter the diagnostic challenges when managing patients with atypical skin lesions, who have a history of leprosy or are residing in endemic country. The ability to accurately diagnose the disease, to detect a relapse of leprosy and to provide appropriate therapy is crucial to avoid the long-term sequelae.
Materials and Methods:
A 50-year-old man was diagnosed with leprosy at age 11 and took complete dapsone monotherapy. This patient had a chronic ulcer after an unhealed contact burn injury on right sole area with intermittent bleeding for 2 years and numerous erythematous annular plaques on abdomen for a few days. The plantar wound was reconstructed with a skin graft and abdominal skin lesion biopsy undertaken.
Results:
The plantar wound healed completely in 3 weeks. Clinical features and the histological findings were compatible with relapsed mid-borderline leprosy. The patient was then started on a multibacillary regimen as recommended by the WHO.
Conclusion:
Accurate diagnosis of relapse leprosy is imperative to prompt treatment and prevention of unnecessary complications.

並列關鍵字

leprosy ； relapse ； plantar ulcer