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Received Dec 4, 2017; Accepted Mar 28, 2018
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1. Introduction
Leprosy, or Hansen’s disease, is a chronic infectious disease caused by the bacillus Mycobacterium leprae, which mainly affects the skin, mucous membranes, and peripheral nervous system [1]. Transmitted by droplets of buccal or nasal origin during close and frequent contact with an infected and untreated subject [2], this disease may manifest itself as a result of motor sequelae in relation to neurological or mutilating bone damage and visceral dissemination that can be life threatening [3]. Although leprosy still occurs with a relatively high prevalence in some countries in Asia and South America [1], leprosy has become a rare disease in Mauritania. We report here two cases of late diagnosis of leprosy despite the persistence of pathognomonic signs.
2. Case Report 1
A 17-year-old farmer residing in Kankossa (Kankossa/Assaba region), Mauritania, spontaneously presented for consultation at Kiffa Regional Hospital on December 2, 2016, for severe chronic arthralgia affecting joints of the hands associated with bilateral perforating plantar ulcer. The patient’s clinical history showed that the cutaneous and neurological signs had evolved for 7 years, which initially presented with hypopigmented maculopapular lesions and paresthesia at the interphalangeal extremities and on the plantar surfaces of the feet. Prior to consultation in our hospital, the patient had seen several dermatologists and traditional healers over the past 7 years. None of these practitioners considered leprosy for differential diagnosis, and the prescribed analgesic, antibiotic, and topical treatments had not improved the patient’s condition.
Physical examination revealed anesthetic distal phalangeal atrophy associated with severe deformity of the hands, hypochromic, anesthetic macular lesions (Figure 1), atrophy of the metatarsals and phalanges with severe deformity of the feet, and bilateral plantar perforations (Figure 2). Hypertrophied nerve trunks were palpable at the ulnar and popliteal level. Visual examination was normal. Clinical diagnosis of lepromatous leprosy was established on the basis of 2 of 3 criteria set by the World Health Organization (WHO) [1]: hypochromic anesthetic skin lesions and palpable peripheral nerves. The third criterion, bacteriological examination of skin smears and/or skin biopsy of infiltrated...