Pathology Page in Clinical Medicine: Leprosy, Borderline- Tuberculoid Type

病理醫學判讀：痲瘋病–偏結核樣型

吳建璋(Chien-Chang Wu) ； 林國璽(Kuo-Hsi Lin) ； 高智泉(Chih-Chuan Kao)

《童綜合醫學雜誌》 12卷1期 (2018/06) Pp. 66-68

摘要

Leprosy, or Hansen's disease, is caused by Mycobacterium leprae, causing skin lesions and nerve damage. Less than 5% of people exposed to M. leprae develop clinical disease. Host cell-mediated resistance determines whether an individual will develop paucibacillary or multibacillary disease. We report here the case of a 32-year-old Indonesian male worker with a 3-year history of hypoesthetic erythematous plaque lesions over his right forearm and 10-day history of multiple nontender papules and nodules located in both forearms, back, and face. Neurologic examination showed decreasing tactile sensation over dermatome of the 1st branch of the 5th cranial nerve (also called as ophthalmic nerve). Skin biopsy revealed histiocytic granulomas. Borderline-tuberculoid type of leprosy was diagnosed based on the classical clinical and pathologic manifestations. Although no indigenous case has been reported in Taiwan hitherto, imported case, as shown in this report, can occur.

關鍵字

Borderline-tuberculoid ； Leprosy ； Hansen's disease

並列摘要

痲瘋病，亦稱為漢生病，是由痲瘋分支桿菌感染所造成的皮膚病灶和神經損傷。而曾接觸過痲瘋桿菌的人，其中不到5% 會造成臨床疾病，此取決於個案本身的免疫能力。免疫能力會影響痲瘋病是否會發展為寡菌量（paucibacillary）或是多菌量（multibacillary）。在這篇病例報告中，一名32歲印尼男性勞工，右手前臂有一個持續三年、局部感覺遲鈍的紅色斑塊以及在十天前，在他的背部、臉部以及雙手前臂出現結節丘疹。神經學檢查出現三叉神經的第一分支皮區觸覺反應減低。針對右手前臂斑塊的皮膚切片，蘇木素伊紅染色出現組織細胞肉芽腫。最終依據典型臨床表現診斷為偏結核樣型痲瘋病。儘管目前台灣並無本土痲瘋病個案，但境外移入案例，如這篇個案報導，卻是有可能發生的。

並列關鍵字

偏結核樣 ； 痲瘋病 ； 漢生病