Diffuse lepromatous leprosy caused by dual infection of mycobacterium leprae and mycobacterium lepromatosis: A case report

M. lepromatosis is the dominant cause of leprosy in Mexico and it co-exists with M. leprae in endemic areas as the once elusive second cause of leprosy. A 41-year-old Madurese woman came with multiple ulcer on her legs, hands and buttock. The ulcers were described as wide and deep, covered with blackish crusts and some exudative area with irregular edges. On face, there were difusse infiltration, madarosis and saddle nose. Histopathology showed thinning of epidermis with a lot of foam cells containing BTA, including endotel and perivascular tissues. Nested PCR examination with LERF2-MLER4 primers for detecting M. leprae showed a positive result. Advanced PCR examination using LPMF2-MLER4 primers for detecting M. lepromatosis also showed a positive result. Based on the clinical, hystopathological results and PCR examination, it was consistent with diffuse lepromatous leprosy. M. lepromatosis mainly causes lepromatous leprosy and also specifically diffuse lepromatous leprosy.