Borderline tuberculoid leprosy and type 1 leprosy reaction in a hepatitis\nC patient during treatment with interferon and ribavirin
A 57-year-old male with hepatitis C using pegylated interferon and ribavirin for\ntreatment of hepatitis C. Four months after the start of the treatment, disseminated\ncutaneous lesions appeared, as well as intense pain along the course of the cubital and\nfibular nerves. Dermatologic examination revealed small and large, highly infiltrated\nerythematous plaques on his back, arms and legs (). Physical examination revealed thickened cubital and fibular nerves that\nwere highly painful to palpation. The patient reported that he had developed a small\nerythematous plaque on his back two years previously, which had been treated\nunsuccessfully as dermatophytosis. In light of the clinical history and the results of\nthe dermatological examination, a hypothesis of borderline tuberculoid leprosy with type\nI reaction was put forward and an incisional biopsy was performed. A histological exam\nrevealed granulomatous inflammatory infiltrate in the upper dermis and around blood\nvessels and hair follicles, but Wade staining and bacteriological examination were\nnegative (). The Mitsuda reaction was\npositive. As the diagnosis was confirmed, six months of multidrug therapy for\npaucibacillary (PB) leprosy was started, together with an initial 80 mg/day dose of\nprednisolone, which was then gradually reduced. After the case was discussed with the\nhepatology team, the decision was taken to interrupt the interferon and ribavirin\ntreatment until the treatment for PB leprosy was completed. There was a clinical\nimprovement in the patient's leprosy reaction (), and he was discharged as cured after completing MDT for PB leprosy (). Six months ago, the patient again began\ntreatment for hepatitis C with interferon and ribavirin, but obtained no sustained\nvirological response and awaiting this release for use of pegylated interferon and\nribavirin associated with protease inhibitor (telaprevir or boceprevir). At the time of\nwriting, the patient is undergoing follow-up at the dermatology and hepatology services\nand has not presented with any clinical manifestations of leprosy reaction.