Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction

Nishikant Borse; Veena Borse; Tanvi Borse; Shiamak Cooper

doi:doi:10.11648/j.ijovs.20210602.18

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Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction

Nishikant Borse, Veena Borse, Tanvi Borse, Shiamak Cooper

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 2)

Received: 13 May 2021 Accepted: 1 June 2021 Published: 15 June 2021

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Abstract

A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to Mycobacterium leprae (M. leprae) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.

Published in	International Journal of Ophthalmology & Visual Science (Volume 6, Issue 2)
DOI	10.11648/j.ijovs.20210602.18
Page(s)	108-114
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Optic Neuropathy, Scleritis, Uveitis, Leprosy, Lepra Reactions

References

[1]	Pandhi D, Chhabra N. New insights in the pathogenesis of type 1 and type 2 lepra reaction. Indian J Dermatol Venereol Leprol 2013; 79: 739-49. https://dermnetnz.org/topics/lepra-reactions/
[2]	Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, et al. Clinical course of erythema nodosum leprosum: An 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg 2006; 74: 868-79.
[3]	Mahendradas P, Avadhani K, Ramachandran S, Srinivas S, Naik M, Shetty KB. Anterior segment optical coherence tomography findings of iris granulomas in Hansen's disease: a case report. J Ophthalmic Inflamm Infect. 2013; 3: 36. doi: 10.1186/1869-5760-3-36.
[4]	Centers for Disease Control and Prevention. Hansen’s disease Updated November 19, 2009. Available at http://www.cdc.gov/nczved/divisions/dfbmd/diseases/hansens_disease/technical.html. Accessed: May 26, 2011.
[5]	World Health Organization (WHO). WHO Expert Committee on Leprosy. 7th Report. Available at http://www.who.int/lep/resources/Expert.pdf. Accessed: May 26, 2011.
[6]	WHO. Leprosy: global situation. World Health Organization. Available at http://www.who.int/lep/situation/en/. Accessed: January 27, 2010.
[7]	Salem RA. Ocular complications of leprosy in yemen. Sultan Qaboos Univ Med J. 2012 Nov. 12 (4): 458-64. [Medline]. [Full Text].
[8]	Prabha N, Mahajan VK, Sharma SK, Sharma V, Chauhan PS, Mehta KS, et al. Optic nerve involvement in a borderline lepromatous leprosy patient on multidrug therapy. Lepr Rev. 2013; 84: 316-21.
[9]	Arora VK, Dhaliwal U, Singh N, Bhatia A. Tuberculous optic neuritis histologically resembling leprous neuritis. Int J Lepr Other Mycobact Dis. 1995; 63: 454-6.
[10]	Chaudhry IA, Shamsi FA, Elzaridi E, Awad A, Al-Fraikh H, Al-Amry M, et al. Initial diagnosis of leprosy in patients treated by an ophthalmologist and confirmation by conventional analysis and polymerase chain reaction. Ophthalmology. 2007; 114: 1904-11.
[11]	Bala Murugan, Sivaraman; Mahendradas, Padmamalini; Dutta Majumder, Parthopratim; Kamath, Yogish. Ocular leprosy: from bench to bedside. Current Opinion in Ophthalmology: November 2020 - Volume 31 - Issue 6 - p 514-520.
[12]	KM Waddell, PR Saunderson. Is leprosy blindness avoidable? The effect of disease type, duration, and treatment on eye damage from leprosy in Uganda. BJO 1995; 79: 250-256.

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APA Style

Nishikant Borse, Veena Borse, Tanvi Borse, Shiamak Cooper. (2021). Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction. International Journal of Ophthalmology & Visual Science, 6(2), 108-114. https://doi.org/10.11648/j.ijovs.20210602.18

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ACS Style

Nishikant Borse; Veena Borse; Tanvi Borse; Shiamak Cooper. Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction. Int. J. Ophthalmol. Vis. Sci. 2021, 6(2), 108-114. doi: 10.11648/j.ijovs.20210602.18

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AMA Style

Nishikant Borse, Veena Borse, Tanvi Borse, Shiamak Cooper. Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction. Int J Ophthalmol Vis Sci. 2021;6(2):108-114. doi: 10.11648/j.ijovs.20210602.18

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@article{10.11648/j.ijovs.20210602.18,
  author = {Nishikant Borse and Veena Borse and Tanvi Borse and Shiamak Cooper},
  title = {Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {6},
  number = {2},
  pages = {108-114},
  doi = {10.11648/j.ijovs.20210602.18},
  url = {https://doi.org/10.11648/j.ijovs.20210602.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210602.18},
  abstract = {A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to Mycobacterium leprae (M. leprae) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.},
 year = {2021}
}

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TY - JOUR
T1 - Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction
AU - Nishikant Borse
AU - Veena Borse
AU - Tanvi Borse
AU - Shiamak Cooper
Y1 - 2021/06/15
PY - 2021
N1 - https://doi.org/10.11648/j.ijovs.20210602.18
DO - 10.11648/j.ijovs.20210602.18
T2 - International Journal of Ophthalmology & Visual Science
JF - International Journal of Ophthalmology & Visual Science
JO - International Journal of Ophthalmology & Visual Science
SP - 108
EP - 114
PB - Science Publishing Group
SN - 2637-3858
UR - https://doi.org/10.11648/j.ijovs.20210602.18
AB - A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to Mycobacterium leprae (M. leprae) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.
VL - 6
IS - 2
ER -

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Author Information

Nishikant Borse

Department of Vitreous & Retina, Insight Eye Clinic, Mumbai, India
Veena Borse

Department of Vitreous & Retina, Insight Eye Clinic, Mumbai, India
Tanvi Borse

Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai, India
Shiamak Cooper

Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai, India

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Plain Text BibTeX RIS

APA Style

Nishikant Borse, Veena Borse, Tanvi Borse, Shiamak Cooper. (2021). Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction. International Journal of Ophthalmology & Visual Science, 6(2), 108-114. https://doi.org/10.11648/j.ijovs.20210602.18

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ACS Style

Nishikant Borse; Veena Borse; Tanvi Borse; Shiamak Cooper. Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction. Int. J. Ophthalmol. Vis. Sci. 2021, 6(2), 108-114. doi: 10.11648/j.ijovs.20210602.18

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AMA Style

Nishikant Borse, Veena Borse, Tanvi Borse, Shiamak Cooper. Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction. Int J Ophthalmol Vis Sci. 2021;6(2):108-114. doi: 10.11648/j.ijovs.20210602.18

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@article{10.11648/j.ijovs.20210602.18,
  author = {Nishikant Borse and Veena Borse and Tanvi Borse and Shiamak Cooper},
  title = {Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction},
  journal = {International Journal of Ophthalmology & Visual Science},
  volume = {6},
  number = {2},
  pages = {108-114},
  doi = {10.11648/j.ijovs.20210602.18},
  url = {https://doi.org/10.11648/j.ijovs.20210602.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210602.18},
  abstract = {A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to Mycobacterium leprae (M. leprae) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.},
 year = {2021}
}

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