CLINICAL CASES   

Giornale Italiano di Dermatologia e Venereologia 2001 October;136(5):401-4

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: Italian

Leprosy in a born and bred Sardinian

Masala M. V., Montesu M. A., Nunzi E. *, Vinci G. F. **, Cottoni F.

Università degli Studi - Sassari Istituto di Clinica Dermatologica * Università degli Studi - Genova Dip. Di Scienze della Salute ** Dermatologia Ambulatoriale ASL n. 5 Oristano

Leprosy is nowadays a pathology still present in Italy mainly due to immigration from countries in which the disease is endemic. Cases in native Italians are rarely seen but some have been reported from mostly rural areas of certain regions such as Liguria, Calabria and Sardinia where, up until relatively recently, pockets of local infection could still be found. We describe here the case of a 72-year-old sardinian woman who first noted the appearance of lesions about thirty years ago: these lesions are erythematous, macular, brownish red in colour, dry on the surface and with clearly defined raised edges. They are furthermore slightly hyperkeratosic and widespread over trunk and upper and lower limbs. Since 1994 the patient has noticed the appearance of asymptomatic ulcerative lesions on the hands. These lesions are characterized by a reduced tendency to scar tissue formation and are accompanied by reabsorption of underlying bone structure. Histological examination of skin lesions revealed granulomatous infiltrate in the medium and deep dermis, mostly localized around some of the blood vessels and skin appendages and perineurally. Some alcohol-acid resistent bacilli showed at Fite-Farraco staining. Neurological and electrophysiological tests showed an alteration in sensitivity to heat and pain. ELISA search for anti PGL-1 antibodies proved positive. On the basis of the above data a diagnosis of borderline tubercular leprosy was made and antibiotic therapy was adopted using rifampicin at 600 mg twice monthly and clarithromycin at 250 mg twice daily.