Rare association between leprosy and erythroderma with diagnostic and therapeutic challenges

Abstract

Objective: To report the case of a patient with multibacillary leprosy associated with drug-induced erythroderma, addressing diagnostic and therapeutic challenges. Case details: A 50-year-old male patient presented with a painful ulcer on his right foot, fever, nausea, and asthenia. Initially treated with tetracycline, he developed cellulitis and disseminated erythematous and desquamative lesions. During the investigation, skin biopsies and intradermal bacilloscopy were performed. Histopathological findings revealed a drug reaction in the erythrodermic area and granulomatous dermatitis with neuritis compatible with leprosy in infiltrated lesions. Considering the multiple lesions, the case was classified as multibacillary leprosy, and a single multidrug therapy combined with methotrexate was initiated to control the erythroderma. Subsequently, the patient experienced a recurrence of erythroderma after tetracycline use, confirming the drug reaction. During the eighth course of multidrug therapy, the erythroderma worsened, and therefore an alternative treatment regimen for leprosy was chosen, replacing dapsone with ofloxacin, considering the diagnostic hypothesis of a new adverse drug reaction. Final considerations: This case highlights the complexity of the differential diagnosis of erythroderma, as well as the rare association between erythroderma and leprosy. Appropriate management involved multidrug therapy, treatment of erythroderma, and guidance on medication use, resulting in a favorable outcome.