Abstract

Hansen disease, historically known as leprosy, is caused by Mycobacterium leprae. The disease is rare in the United States but remains endemic among certain immigrant populations, and may manifest years after infection. The US military has a number of active duty troops originally from endemic countries. Recently, three US soldiers with Hansen disease were evaluated at Walter Reed Army Medical Center. The mean time to diagnosis was 8 months (range, 2 to 18 months). All three patients were initially misdiagnosed and treated for other skin infections or contact dermatitis. These cases illustrate the importance of prompt recognition and treatment of Hansen disease to prevent permanent disability and disfigurement. The clinical presentation, diagnosis, classification, and currently recommended therapeutic regimens for Hansen disease are discussed.

Key Points

* Despite the low incidence of leprosy in the United States, certain populations, including immigrants, remain at risk for the disease.

* The average time to diagnosis in the United States is approximately 2 years from presentation, which can lead to unnecessary complications.

* Leprosy should be considered in any patient with a nonhealing skin lesion, especially if they have neurologic deficits or have lived in an endemic area.

* Classification of leprosy into paucibacillary and multibacillary disease is not only academic but directs appropriate therapy.

* Reversal reaction and erythema nodosum leprosum are two reactional episodes that can occur in leprosy patients at any time during the disease.