Delayed diagnosis of Hansen's disease (leprosy) can have serious neurological consequences. The typical skin lesions and classic neuropathy of leprosy are readily recognized in countries where the disease is more common, but in the United States, where leprosy is rare, it can be difficult to diagnose. Physician awareness is key to the early diagnosis and treatment that can prevent disability.
Consider the diagnosis of leprosy when...
Patient presents with non-responsive skin lesion and is:
- Immigrant from country with high incidence of leprosy
- U.S. resident with history of foreign travel
- Resident of Texas or Louisiana
- Has referral history of multiple physician/specialist and/or frequent emergency room visits
Watch Video: When to Suspect Leprosy: Clinical Aspects and Treatment of Uncomplicated Hansen's Disease
Cardinal signs
- Localized skin lesions
- Raised or flat
- Light or pigmented
- Sensory loss in lesion
- Thickened peripheral nerves
- Demonstrated acid-fact bacilli in lesion
Laboratory tests
- There are no serological, culture and sensitivity (C&S) or skin tests
- Skin biopsy is needed for definitive diagnosis
- PCR for M. leprae and M. lepromatosis DNA detection is available from NHDP
Patients with delayed diagnosis
Because of a delay in diagnosis, patients may present for diagnosis of Hansen's disease who are already undergoing a Reversal or ENL reaction:
- Acute, immunological complications may confuse clinical picture
- Acute inflammation of lesions
- Neuritis
- Arthritis
- Edema, loss of sensation and weakness in the hands or feet
- Such patients often have seen multiple specialists
Seek consultation with National Hansen's Disease Program. Phone 1-800-642-2477 (in Hawaii: 1-808-733-9831).