A rare case of pulmonary tb and leproniatous leprosy coinfection with type 2 lepra reaction

SESSION TITLE: Severe complications of Bacterial Infections SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: Tuberculosis and leprosy are endemic to developing countries. Coinfection at the same time is very unusual and rare. Several coinfections were documented in the past, but most were diagnosed in chronological sequence, with one occurring after the other. CASE PRESENTATION: A 45-year-old diabetic male presented with sudden acute onset right-sided pleuritic chest pain and shortness of breath to an urban hospital in Southern India. He had associated cough with productive sputum, low-grade intermittent fever, loss of appetite, and weight loss for the past two months. Chest X-ray showed right-sided pneumothorax, and he underwent chest tube placement. Pleural fluid was positive for Acid Fast Bacilli(AFB) on smear, and Mycobacterium tuberculosis (MTB) resistant to rifampicin was detected on cartridge-based nucleic acid amplification test (CBNAAT). He was also found to have multiple erythematous painful nodules all over the body, muscle wasting, and loss of eyebrows concerning Type 2R reaction (erythema nodosum leprosum). Slit skin smear demonstrated Mycobacterium leprae and was started on Dapsone, Clofazimine, and prednisone. Pleural fluid culture sensitivities were sent, showing resistance to rifampicin and isoniazid. He was then started on an MDR regimen and had eventual clinical improvement. DISCUSSION: Leprosy-TB coinfection is rare, possibly due to the different mycobacterial reproduction rates and the possible cross-immunity between the two organisms.[1] In most leprosy-TB coinfections, TB follows leprosy infection. An undiagnosed leprosy-TB coinfected patient runs the risk of receiving rifampin monotherapy and the subsequent development of rifampicin-resistant TB during leprosy therapy. Sputum and a chest radiograph should be done in the initial work-up of a patient with leprosy. Also, a positive IGRA or PPD test in a patient with leprosy should not be considered false-positive without ruling out active TB. Furthermore, substituting minocycline for rifampicin whilst awaiting the TB screening results and close clinical monitoring can help prevent adverse outcomes. CONCLUSIONS: Coinfection of TB and leprosy is rare, and there is a high probability of MTB being multidrug-resistant in such instances. Clinicians should keep this in mind and consider ruling out one if another is present. Reference #1: Mangum L, Kilpatrick D, Stryjewska B, Sampath R. Tuberculosis and Leprosy Coinfection: A Perspective on Diagnosis and Treatment. Open Forum Infect Dis. 2018;5(7):ofy133. Published 2018 Jun 5. doi:10.1093/ofid/ofy133 DISCLOSURES: No relevant relationships by sahasreddy jitta No relevant relationships by Harshitha Mergey Devender No relevant relationships by AKASH POLASA No relevant relationships by Abira Usman No relevant relationships by Vishruth Vyata