Description

Ceprosy is a chronic infectious disease caused by Mycobacterium leprae. It also known as Hansen’s disease. In this disease mostly skin, peripheral nerves, mucosal surfaces of upper respiratory tract and eyes are affected. Ranging from childhood to old age, it can occur to all age group people. Leprosy is curable and if treated early can prevent disability. In 2014-15 the number of leprosy cases detected was 1,25,785, now the cases have come down to 75,394 in 2021-22, accounting for 53.6% of total global new leprosy cases. We here report the case of 70 years old male patient came to the hospital with the known history of leprosy for 1.5 years, complaints of haematemesis (2 episodes), dysphagia and loss of appetite since 4 months. There was a history of associated fever and weight loss (20 kgs). On physical examination, hyper and hypo pigmented patches were present over bilateral upper and lower limbs. Ulcer of size 3 X 2 cms present over dorsal aspect of left foot which were having regular margins and bleeds on touch. There was tenderness present in epigastric region and no organomegaly was noted. His CBC investigations were all normal except his Hb level which was 7.9 gm%. Endoscopy was also done which revealed a fungating mass at the gastroesophageal junction (GEJ) with salmon coloured mucosa proximal to the mass. A biopsy was then done which showed an irregular, angulated, infiltrating back to back glands with minimal intervening stroma. The glandular proliferation is composed of cells with enlarged hyperchromatic nuclei. The patient was then diagnosed with Malignant neoplasm of oesophagus. The treatment was started with antibiotic, multivitamin, iron supplements, analgesics and chemotherapeutic drugs.

Figure 1: Advanced tissue destruction in the legs due to leprosy.