A 54-year-old Sinhalese man, an intravenous substance abuser, a tobacco smoker, and alcoholic, who was a garbage truck worker by occupation, with a close contact history of leprosy (his daughter), presented with leonine face and asymptomatic infiltrated papules and plaques over his earlobes of 5 months’ duration and hypopigmented hypoanesthetic patches all over his body for a similar duration (Fig. ). His skin smear and skin biopsy were compatible with borderline lepromatous leprosy. He had a normal BMI; a neurological examination was normal. He had received a BCG vaccination. He was commenced on multibacillary treatment for leprosy (dapsone 100 mg/day, clofazimine 50 mg/day and 300 mg/once a month and rifampicin 600 mg/month) with tailing-off of dose of prednisolone starting from 40 mg daily. Six months later, he presented with productive cough with nocturnal pyrexia; an evaluation revealed high ESR (130 mm/hour), CXR evidence of active pulmonary TB, and positive sputum smear for AFB. Immune function studies carried out to evaluate his immunodeficiency status did not reveal any congenital or acquired immunodeficiency conditions, including diabetes and HIV. Table gives the basic investigations. He was commenced on TB (isoniazid 300 mg/day, rifampicin 450 mg/day, ethambutol 800 mg/day, and pyrazinamide 1500 mg/day) treatment. He defaulted treatment several times with regards to both leprosy and TB and later died due to TB. 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.