Borderline Lepromatous Leprosy with Type 1 (Reversal) Reactions in a Chinese Man.

A 59-year-old man diagnosed with borderline lepromatous leprosy developed reddish patches and plaques on the face, which progressively enlarged and spread to the trunk and limbs. Other superficial nerves appeared normal.

Biopsy showed plasmocytic and lymphocytic infiltration in the nerve tract, and was 4+ acid-fast bacilli (AFB)–stain positive suggesting Mycobacterium leprae; this was confirmed by real-time polymerase chain reaction (PCR). The HLA-B*13:01 test was negative. Two weeks after rifampin, dapsone, and clofazimine (World Health Organization multidrug therapy [WHO MDT] regimen) were started, the skin lesions (hypochromic macules) became red, edematous, and enlarged. Both ulnar nerves became tender and thickened; ultrasonography showed reduction of blood flow. Collectively these findings indicated a type 1 conversion reaction (T1R).

One year after prednisone was started (40 mg/day for 3 months with progressive tapering), the T1R was found to be completely resolved.