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Case R e po r t
Department of Pulmonary Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
Address for correspondence:
Dr. Satyadeo Choubey, M5-12, Meghdoot Apartment, Jawaharlal Nehru Medical College, Datta Meghe
Institute of Medical Sciences Campus, Sawangi (Meghe), Wardha - 442 004, Maharashtra, India.
E-mail: chestsd@gmail.com
Abstract
The concomitant occurrence of the two oldest mycobacterial diseases that is tuberculosis and leprosy in a single individual is not
rare but has been infrequently reported. Herein, we report a case of 34yearold laborer who concomitantly presented with both
sputum positive pulmonary tuberculosis and lepromatous leprosy. The diagnosis of the two diseases was made simultaneously,
which is again infrequent in literature. The treatment of leprosy warrants screening of individual for tuberculosis because
multidrug therapy for leprosy may lead to acquired drug resistance for rifampicin, which is a mainstem of antitubercular therapy.
Key words: Coinfection, leprosy, tuberculosis
INTRODUCTION
Both tuberculosis and leprosy are chronic granulomatous
disease caused by Mycobacterium tuberculosis and Mycobacterium
leprae, respectively. The infrequent occurrence of these
two diseases in a single individual is explained by their
transmission dynamics that is the higher reproductive rate
of tubercular bacilli than the lepra bacilli and the degree
of cross immunity they offer in an individual. We report a
case of lepromatous leprosy and pulmonary tuberculosis
in an individual diagnosed simultaneously, at his first
hospital visit.
CASE REPORT
A 34yearold male, laborer by occupation was admitted
with complaints of mucopurulent cough, fever(typical
evening rise) and breathlessness for two months and
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DOI:
10.4103/2320-8775.126512
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DISCUSSION
Both leprosy and tuberculosis have been prevalent in India
since ancient times with current prevalence rate of active
tuberculosis estimated to be 4.0 and 16.0 per thousand
bacteriologically and radiologically, respectively and that
of leprosy 0.88 per thousand.[1]
Leprosy, especially the multibacillary, leads to depressed cell
mediated immunity which may either reactivate the latent
tubercular infection or make the person susceptible for
new infection. Defect in Tolllike receptor 2(TLR2) may
blunt the triggering of host defense mechanism. Reduced
inducible chemokine ligand2(CCL2) and tumor necrosis
factor(TNF)alpha responses in lepromatous leprosy
contribute to unrestricted growth and dissemination of
tubercular bacilli.[2,3]
Revich etal.,[4] in 1954 reported the association to be
maximum in lepromatous leprosy followed by borderline
and uncommon in tuberculoid form. Gajwani etal.,[5] in
1968, Gupta etal.,[6] in 1971 and Agnihotri MS,[7] etal., in 1973
reported cases of tuberculoid leprosy with tuberculosis.
Kumar B etal.,[8] in 1982 concluded that tuberculosis can
occur during full spectrum of leprosy[Table1].
Both leprosy and tuberculosis are commonly spread
via aerosol.[10] Incubation period varies from 6 months
to 40years for leprosy and 4weeks for tuberculosis.
Coinfection may have a gap of 2 months to 10-15years.[2]
Usually leprosy predates tuberculosis but the reverse has
also been reported as by Agnihotri MS etal.,[7] in 1973. In
our case, both the diseases were diagnosed simultaneously.
Tuberculosis has also been reported with the use of
glucocorticosteroids used in the treatment of leprosy
primarily in type1(reversal) reactions and type2 and silent
neuropathy. In our case the patient was not on steroid or
other immunosuppressive therapy neither he had other
risk factors in the form of HIV infection, silicosis, diabetes
mellitus, gastrectomy, renal failure, organ transplants, or
smoking habits. The only precipitating event can be his
lower socioeconomic status.
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No. of cases
reported
First
infection
Type of
leprosy
Type of tuberculosis
(pulmonary/extrapulmonary)
6 months-2years
2
3
BT2
TT1
TT
TT
Pulmonary
Pulmonary
Pulmonary
6 months-1year
1 month-4years
20
TB2
Leprosy1
Leprosy
TB2
Leprosy1
Leprosy
Pulmonary18
Pleural effusion2
10-15years
Leprosy
Pulmonary
NA
1
1
Leprosy
Leprosy
LL15
BL3
TT2
LL4
BL3
TT2
LL
BL
Pulmonary
Pulmonary
10years
9 months
TB: Tuberculosis, BT: Borderline tuberculoid leprosy, TT: Tuberculoid leprosy, BL: Borderline lepromatous leprosy, LL: Lepromatous leprosy
CONCLUSION
Rifampicin is a bactericidal drug and constitutes important
drug in the treatment regimen of both leprosy and
tuberculosis. So the latter must be screened out in each
patient of leprosy to avoid acquired drug resistance to
rifampicin due to single drug therapy.
REFERENCES
1.
2.
3.
2006;63:2417.
RelvichAL. The treatment of tuberculosis in leprosy patients. Lepr
Rev 1954;25:17986.
5. Gajwani BW, Verma BS, Marwaha RK, Pande RS. Simultaneous
infection with M. tuberculosis and M. leprae. JAssoc Physicians India
1968;16:5634.
6. GuptaMC, PrasadM. Associated infection of pulmonary tuberculosis
and leprosy. Indian J Med Sci 1971;25:1835.
7. Agnihotri MS, Rastogi S, Agarwal RC. Tuberculosis and leprosy.
Indian J Tub 1973;20:1367.
8. Kumar B, Kaur S, Kataria S, Roy SN. Concomitant occurrence of
leprosy and tuberculosisA clinical, bacteriological and radiological
evaluation. Lepr India 1982;54:6716.
9. Srilakshmi MA, Amit H, Jayantilal, Raveendranath S, Pais N.
Concomitant infection with pulmonary tuberculosis and
lepromatous leprosy. JAssoc Physicians India 2003;51:5289.
10. Leprosy(Hansen's disease): Technical Information. Available from:
http://www.cdc.gov/nczved/divisions/dfbmd/diseases/hansens_
disease/technical.html.[Last accessed on 2014 Jan 03].
11. Flanagan PM, McIlwain JC. Tuberculosis of the larynx in a
lepromatous patient. JLaryngol Otol 1993;107:8457.
4.
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