SHM Converge Scientific Abstract ePoster Gallery-Leprosy in a Recent Immigrant: Diagnosis Barriers and Treatment Updates

Pdf Summary

This case describes a 30-year-old man with no significant past medical history who presented with a 6-month history of progressive diffuse hypopigmented and erythematous skin lesions. He had recently immigrated to the United States from Peru after a difficult 4-month overland journey through the Darién region of Panama, where he experienced many insect and mosquito bites.<br /><br />On exam, he was afebrile and hemodynamically stable, but had diffuse pruritic, non-purulent papules and plaques affecting the hands, fingers, ears, testicles, and anterior sinuses, with some open lesions and testicular edema. The presentation was consistent with lepromatous leprosy (Hansen’s disease).<br /><br />The case highlights two main teaching points: first, clinicians should recognize the signs and symptoms of Hansen’s disease, especially in patients with relevant travel or migration history; second, significant barriers can delay diagnosis in recent immigrants, including language barriers, fear of deportation, lack of insurance, and low clinical suspicion for rare tropical infections.<br /><br />It also emphasizes the importance of a thorough social and travel history and early involvement of infectious disease specialists. Migrants passing through regions such as the Darién Gap may be exposed to unusual infectious diseases that are uncommon in destination countries.<br /><br />Traditional treatment for Hansen’s disease has been dapsone, rifampin, and clofazimine for 24 months, but clofazimine can cause non-reversible skin discoloration. A newer alternative regimen of monthly rifampin, moxifloxacin, and minocycline for 12 months has been shown to be non-inferior and was selected in this case to avoid permanent pigmentation changes.

Asset Subtitle

Sanjna Vinze

Meta Tag

Author List Elizabeth Esselman, Gabrielle Montalbano, Morgan Edwards-Fligner, Sanjna Vinze

Category Clinical Vignettes

Concept Lepromatous Leprosy

Concept Skin Lesion

Concept Nerve Involvement

Concept Social History

Concept Travel History

Distinguished Non-Finalist

Presenter Organization University of Colorado

Presenting Author Sanjna Vinze

Track Adult

Keywords

lepromatous leprosy

Hansen disease

hypopigmented skin lesions

erythematous papules

recent immigrant

Peru migration

Darién Gap

insect bites

rifampin moxifloxacin minocycline

infectious disease diagnosis

Lepromatous Leprosy

Skin Lesion

Nerve Involvement

Social History

Travel History