01323nas a2200169   4500000000100000008004100001260001200042653001200054653003000066100001200096700001300108700001400121700001500135245008600150520090300236022001401139       2022                            d  c11/202210aleprosy10aPERIPHERAL NEUROPATHOLOGY1 aLeung A1 aArnold B1 aHodgson T1 aCutfield N00aLeprosy rash precipitated by immunotherapy for suspected inflammatory neuropathy.3 a<p>Leprosy is a chronic granulomatous infection caused by complex, causing skin and nerve lesions with potential for permanent disability. Leprosy can be overlooked in Western settings, as it is more prevalent in low-income and middle-income countries. We describe a 38-year-old woman with a 4-year history of progressive numbness of the left hand incorrectly diagnosed as multifocal acquired demyelinating sensory and motor neuropathy on the basis of clinical and neurophysiological findings. Treatment with empirical weekly corticosteroid followed by intravenous immunoglobulin resulted in the sudden development of a widespread rash; we then diagnosed borderline lepromatous leprosy on skin biopsy. We postulate that the immune treatments induced a temporary state of immune tolerance followed by a rebound of a T cell-mediated immune response resulting in a type 1 immunological response.</p>
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