Case presentation

Leprosy Mailing List – November 5thr, 2010

Ref.:   Case presentation

From: Tamang Krishna, Dhanusa , Nepal

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Dear Dr Noto,

I am Dr. Krishna working at Lalgadh Hospital , Nepal .  About 2 months ago we diagnosed a 52 years male with multibacillary (MB) leprosy.  On diagnosis he was presenting with diffuse infiltration on face and type two reaction.  We screened  for  diabetes and hypertension before starting prednisolone.  We started MB multi-drug therapy (MDT) and prednisolone with standard protocol with 40mg 2 weeks and taper down 30mg.

He was complaining headache and faintness.  We admitted him for screening; his  blood sugar  was  high about 250 mg.  He was sent home with oral hypoglycaemic drug (glibencamide 5 mg once daily) again after two days he complained sudden loss of vision in his left eye with ptosis.  We immediately referred to ophthalmologists who diagnosed central retinal artery occlusion. He was again taken to physician and started human insulin and admitted in hospital about 10 days.  At this point, during the course of treatment he developed ulcer on the soft palate and get  perforated.  They did biopsy and found fungus.

This is my bitter experience.  The patient deteriorated very fast; ct scan of head was done and every thing was normal.  Now he is on MB-MDT and oral hypoglycaemic drug.  His blood sugar is under control, but he has perforation of palate.  He severe difficulty in drinking and eating; it will regurgitate from nose.

Could you please comment?  Have anyone faced such problem?

Thank you,

Dr. Krishna Bdr Tamang (lama)

Lalgadh Hospital

Dhanusa

Nepal