Severe type I lepra reaction in a patient with Hansen’s disease and COVID-19. Therapeutic challenges

India contributes approximately 60% of the annual global burden of leprosy despite declaring elimination in December 2005 [1]. The ongoing COVID-19 outbreak in India is a part of the world-wide pandemic caused by severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2). Although all exposed individuals are equally susceptible to acquire this infection, certain subsets of population are more likely to become severely ill [2]. This includes the elderly (age > 60 years) and those with co-morbidities like cardiovascular diseases (hypertension, persons who have heart disease or stroke), chronic respiratory diseases (chronic obstructive pulmonary disease), diabetes mellitus, cancer and ongoing chemotherapy and immunosuppression. Certain laboratory such as neutrophilia and elevated levels of lactate dehydrogenase (LDH) are also associated with a greater risk of the development of severe forms of COVID-19 [3].
There have been no reports so far of leprosy patients co-infected with COVID-19. Dermatologists are facing a myriad of challenges while managing various dermatological diseases during the current COVID-19 pandemic. We encountered a similar situation while treating a lactating female with BT Hansen’s disease in severe type I lepra reaction presenting with a mild grade of COVID-19 upper respiratory tract infection (URTI).
A 28-year-old lactating female (4 months post-partum), diagnosed with borderline tuberculoid (BT) leprosy on multidrug therapy for last 6 months (dapsone 100 mg OD, clofazimine 300 mg monthly and 50 mg OD, rifampicin 600 mg monthly) presented with skin OPD with complaints of pain and swelling over bilateral elbow joints and hands along with cough, fever, runny nose, loss of taste and smell for 8 days. Dermatological examination revealed shiny hypopigmented hypoesthetic patches over the back, buttocks, upper and lower limbs. Upon peripheral nerve examination, she had bilateral grade 3 ulnar neuritis. On motor examination, she had a right-sided foot drop of recent onset as well as bilateral mobile ulnar claw hands. On the basis of detailed clinical examination and a positive RT-PCR test for COVID-19, she was diagnosed as BT Hansen’s disease with type I reaction and concomitant COVID-19 infection. She was immediately admitted to the COVID-19 isolation ward and started on supportive management with regular laboratory monitoring and SpO₂ charting (in the range of 90% to 92%). Her laboratory parameters revealed...


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