Indeterminate leprosy and lepromatous index case: four cases in the same\nfamily
Patient A was 8 years old, female, and HIV +. She was using no medications and presented\na single hypochromic lesion on the left forearm. Biopsy of the lesion was compatible\nwith indeterminate leprosy (). During the\nchild's consultation, the mother (patient B), who was 34 years old, had been HIV + for 8\nyears and on antiretroviral therapy for 7, complained of a macule on the left arm which\nhad appeared about 1 year earlier and which had started to show elevated borders 1 month\nbefore the consultation, with reduction of thermal sensitivity (). On the next consultation, the mother brought another\ndaughter (patient C), who was 19 years old and presented a hypochromic macula with\nreduced thermal sensitivity in the lateral region of the right knee (). Biopsies of lesions from patients B and C\nwere also compatible with indeterminate leprosy. There was no thickening of nerves in\npatients A, B or C. The three patients were diagnosed with indeterminate leprosy, and\npaucibacillary-multidrug therapy was started. We did not perform the Mitsuda test\nbecause it was not available in our service.\nConsidering the 3 cases, we sought to identify a possible source of infection among\nclose family members. The patients initially denied knowing about anyone close who had\nskin lesions. When we showed them a photo of a lepromatous patient in a book, the\npatients reported on a relative who presented similar lesions. Patient D, who is male,\npatient B's brother and patients A and C's uncle, was then brought by the family. He\npresented weakness and numbness in both hands, in addition to nasal obstruction. On\nexamination, he showed nodules and tubercles on the face and pinnas, bilateral\nmadarosis, diffuse infiltration in the trunk and lower limbs (). There was cubital and auricular nerve thickening, which\noccurred bilaterally. There was hypoesthesia in bilateral legs and feet, hypoesthesia of\nthe whole left arm and right arm (). Skin\nsmears were positive. Multibacillary multidrug therapy was initiated.\nThe four patients are from Laguna, Santa Catarina. Patients A, B and C live in the same\nhouse. Patient D lives close, on the same street, and often visits the other patients.\nFour people were considered close contacts of the patients. These contacts did not want\nto be examined in our service, so they were advised to seek examination in the health\ncenter of their city of origin. Patients A and B completed treatment and were discharged\nas cured, presenting the characteristics they showed on the first physical examination.\nPatients C and D received 5 doses and asked to finish the treatment in their hometown.\nThe cases were then transferred.