Leprosy: The Neglected Infectious Disease

Summary: Introduction Back in the day, leprosy was one of the dreaded infectious diseases in Malaysia. It has been officially eliminated since 1994, and is rarely encountered in the forensic pathology practice. However, the number of cases resurges steadily, and may have spread within the community over the years. Here, we report a case of leprosy with concurrent pulmonary tuberculosis to highlight the role of forensic pathology in aiding infection control surveillance in Malaysia. Case Report A middle-aged Indonesian man with historic recurrence of hand swelling and foot ulceration, was brought dead to the mortuary. There were night sweats, intermittent fever and lethargy, however there were no previous chronic cough, haemoptysis or breathing difficulty. Externally, there were facial disfigurement, hand deformities and localized hypopigmented lesions on the feet. Lung examination showed generalized pleural adhesions with nodular necrotic tissues. The histological findings of the earlobes, skin lesions and ulnar nerve showed diffused foamy histiocytic infiltrates of lepra cells with numerous acid-fast bacilli within the dermis and nerve. The lung histology showed granulomatous caseating necrosis, whereas the lung culture isolated Mycobacterium tuberculosis complex. The ultimate cause of death was determined to be pulmonary tuberculosis. Conclusion Information gathered from forensic pathology practices could play a role in the preventive pathology aspect. In this case, identification of leprosy and tuberculosis, and notification to the authorities will help public health to improve the infection control surveillance system by conducting contact tracing and providing early medical intervention, thus preventing further spread into the local community.