Abstract | December 16, 2022

SARS-Cov-2 Infection Uncovering Latent Mycobacterium Leprae Infection

Presenting Author: Isabella Dreyfuss, BS, Medical Student, Nova Southeastern University, Davie, FL

Coauthors: Christopher Mancuso, DO, MHS , Paloma Reiter, DO , Regina Zambrano, DO , Ritu Saini, 11 MD , Suzanne Sirota-Rozenberg, DO; 1 St. John’s Episcopal Hospital, Department of Dermatology, Far Rockaway, New York; 2 St. John’s Episcopal Hospital, Department of Family Medicine, Far Rockaway, New York

Learning Objectives

  1. Discuss two theories of how COVID-19 can exacerbate or trigger Type 1 and Type 2 leprosy.
  2. Measure the immunologic leprosy reactions triggered by stress and infections.
  3. Diagnose the facial and dermatologic features of leprosy, including edematous and erythematous plaques of his forehead, periocular areas, nose, malar cheeks, and temples.

Introduction: As the number of coronavirus disease 2019 (COVID-19) cases rise globally, more information is being brought to the light regarding the relationship between COVID-19 and leprosy. There are very few reports of leprosy with concurrent COVID-19. Limited literature suggests two theories have been postulated thus far: (1) COVID-19 infection may trigger a leprosy reaction; and (2) leprosy treatment may cause patients to experience a severe manifestation of COVID-19 infection. 

 

Case Presentation: A 46-year-old Fitzpatrick VI, African- American man with a significant past medical history of recent COVID-19 infection in April 2020 presented to the dermatology clinic on July 2, 2020 with a three-week history of a rash on his face. The patient reported that he migrated from Guyana three years ago and did not have a history of or exposure to leprosy. Of note, the patient did admit to an increased amount of stress amidst the COVID-19 pandemic. On physical examination, the patient had multiple edematous and erythematous plaques of his forehead, periocular areas, nose, malar cheeks, and temples; forming the classical leonine facies. The 3mm punch biopsy was reported as multibacillary leprosy with innumerable beaded or fragmented organisms. The patient was started on Clofazimine 50mg daily and Rifampin 600mg daily, and sent for glucose- 6-phosphate dehydrogenase deficiency testing before starting Dapsone 100mg daily. Infectious disease was consulted for further management and the Health Department was notified. 

 

Final/Working Diagnosis: The first theory states that COVID-19 is a risk factor for triggering a leprosy reaction due to its effect on various immunologic events. Type 2 leprosy is known to be associated with dermal neutrophil infiltrate, leading to skin disfiguration. Overall, this first theory suggests that COVID-19 may trigger lepromatous reactions. The second theory proposes that leprosy patients undergoing active treatment with anti-inflammatory medications are at an increased risk of acquiring severe manifestations of COVID-19. 

 

Management/Outcome: Leprosy reactions may be triggered by stress and infections, and the COVID-18 pandemic has caused significant emotional and psychological stress on patients. When considering this and the two theories proposed, our unique case suggests that COVID-19 may induce or exacerbate leprosy reactions.

References:

  1. Rathod S, Suneetha S, Narang T, et al. Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by SIG Leprosy (IADVL Academy). Indian Dermatol Online J. 2020;11(3):345-348. Published 2020 May 10. doi:10.4103/idoj.IDOJ_234_20
  2. Schmitz V, Dos Santos JB. COVID-19, leprosy, and neutrophils. PLoS Negl Trop Dis. 2021;15(1):e0009019. Published 2021 Jan 7. doi:10.1371/journal.pntd.0009019itz
  3. Antunes DE, Goulart IMB, Goulart LR. Will cases of leprosy reaction increase with COVID-19 infection? PLoS Negl Trop Dis. 2020;14:e0008460 10.1371/journal.pntd.0008460
  4. Santos VS, Quintans-Júnior LJ, Barboza WS, Araújo AAS, Martins-Filho PR. Clinical characteristics and outcomes in patients with COVID-19 and leprosy [published online ahead of print, 2020 A
  5. Nery JA, Bernardes Filho F, Quintanilha J, Machado AM, Oliveira Sde S, Sales AM. Understanding the type 1 reactional state for early diagnosis and treatment: a way to avoid disability in leprosy. An Bras Dermatol. 2013;88(5):787-792. doi:10.1590/abd1806- 4841.20132004
  6. Bilik L, Demir B, Cicek, D. Leprosy Reactions.
  7. Hansen’s Disease – The Forgotten and Neglected Disease. 2019. doi: 10.5772/intechopen.72481
  8. Thng ZX, De Smet MD, Lee CS, et al. COVID-19 and immunosuppression: a review of current clinical experiences and implications for ophthalmology patients taking immunosuppressive drugs [published online ahead of print, 2020 Jun 12]. Br J Ophthalmol. 2020;bjophthalmol-2020-316586. doi:10.1136/bjophthalmol-2020-316586
  9. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(1):30. Published 2013 Aug 15. doi:10.1186/1710-1492- 9-30
  10. Barnes BJ, Adrover JM, Baxter-Stoltzfus A, et al. Targeting potential drivers of COVID-19: Neutrophil extracellular traps. J Exp Med. 2020;217(6):e20200652. doi:10.1084/jem.20200652
  11. Mehta P, McAuley DF, Brown M, et al. COVID- 19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-1034. doi:10.1016/S0140-6736(20)30628-0
Back to Abstracts