A rare case of lepromatous leprosy in Germany

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Dear Editors,A 56-year-old male patient presented to our university outpatient clinic for the first time.He reported having progressively growing, distressing lesions on his face and distal forearms for several months.He described reduced sensitivity within the affected areas.The patient, originally from Ghana, has been living in Germany for an extended but unspecified period of time, working as a hotel cleaner.He had previously been treated by dermatologists and ENT specialists under the working diagnosis of rhinophyma, but without clinical improvement.Beside a monoclonal IgG gammopathy of unclear significance, there was no record of previous illnesses or ongoing long-term medication.Symmetrical, hypesthetic, confluent flesh-colored papules and nodules without epidermal changes were observed centrofacially, involving the forehead, nose, cheek, and lip.There was also rarefaction of the lateral eyebrows (Figure 1).On the distal forearms, individual, ulnar-sided, subcutaneous, indolent nodules were present.Multibacillary lepromatous leprosy was suspected, associated with the typical leonine facies.Further diagnostic workup was immediately initiated, and the suspected case was reported to the responsible health authorities.Using RLEP-Real-Time-qPCR, Mycobacterium leprae could be detected in swab material from the nasal mucosa and in two skin biopsies from the forehead, with a high bacterial load (nasal mucosa: approx.35,000 bacteria in 50 μL DNA extract; Skin biopsies: approx.668,000 and 750,000

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