A 47-year-old Tamil woman with poorly controlled long-standing diabetes mellitus presented with facial infiltration, multiple ichthyotic patches, and peripheral neuropathy associated with Charcot joints and trophic ulcers (Fig. ). She was a homemaker with poor social background and there was no contact history of TB or leprosy. She did not smoke tobacco or drink alcohol. She had received a BCG vaccination. She had a low BMI and a respiratory examination revealed B/L coarse crepitations. There was no peripheral neuropathy. A clinical diagnosis of lepromatous leprosy was made which was later confirmed with histology and slit-skin smears: bacteriological index (BI) of 5; morphological index (MI) of 2%. Initial investigations revealed persistently elevated ESR (100–122 mm/hour) and inflammatory shadows in a CXR. Two consecutive sputum smears were positive for AFB and the result of a Mantoux test was positive (18 mm). Her liver and renal functions were normal (Table ). She was negative for HIV screening. She was commenced on both TB (isoniazid 300 mg/day, rifampicin 450 mg/day, ethambutol 800 mg/day, and pyrazinamide 1500 mg/day) and multibacillary leprosy treatment (dapsone 100 mg/day and clofazimine 50 mg/day and 300 mg/once a month) without a monthly loading dose of rifampicin. She had poor compliance and defaulted treatment several times and ultimately succumbed to the illness. An autopsy was not performed.
A 72-year-old Tamil man presented with a 2-year history of trophic ulcers, auto-amputated fingers, and facial infiltration (Fig. ). He was a retired mason from a poor social back ground with low income and did not have any other medical diseases. A general examination and neurological examination was normal. There was no significant contact history of leprosy or TB. He had received a BCG vaccination. He was an ex-smoker of tobacco and an ex-drinker of alcohol. His evaluation confirmed the clinical diagnosis of leprosy with highly positive slit-skin smears and histological evidence of lepromatous leprosy. He also gave a history of constitutional symptoms, evening pyrexia, and loss of weight and appetite. His ESR was 113 mm/hour and a sputum examination revealed AFB along with positive Mantoux test of 14 mm and CXR evidence of pulmonary TB. Basic investigations are given in Table . He was evaluated for both congenital and acquired immunodeficiency status, which did not reveal any abnormality. Although treatment for both conditions was commenced (isoniazid 300 mg/day, rifampicin 450 mg/day, ethambutol 800 mg/day, and pyrazinamide 1500 mg/day and dapsone 100 mg/day and clofazimine 50 mg/day and 300 mg/once a month) in liaison with a respiratory team, he was lost to follow up.