C-196. Lepromatous Hansen's Disease in an Elderly Man from Northwest Louisiana

R. G. Washburn1,2, J. W. King2,1, G. M. Kent1,2, R. E. Normand1, V. L. Moore1, T. S. Rowland1, S. A. Dauenhauer1,2;
1Shreveport VA Med. Ctr., Shreveport, LA, 2Louisiana State Univ. Hlth. Sci. Ctr., Shreveport, LA.

History: An 83 year old man from northwest Louisiana was evaluated for 6 months of nonpruritic erythematous papular rash involving the torso, arms and legs associated with paresthesias and dysesthesias in the hands and feet. Past medical history was notable for type II diabetes mellitus, hypertension, and coronary artery disease. He lived all his life in Louisiana, working as a painter until age 77 and living on his own farm until age 80. He never left the continental United States and denied contact with individuals having rash and numbness. Objective findings: Neurological examination revealed decreased temperature sensation and proprioception in a stocking glove distribution over the hands and feet, associated with decreased vibratory sensation involving the great toes. Skin biopsy revealed perivascular inflammation. Subsequent Ziehl Neelsen staining showed numerous intracellular acid fast bacilli contained within foamy macrophages in perivascular and perineural areas. Mycobacterial cultures yielded no growth. Clinical course: This patient was diagnosed with multibacillary lepromatous Hansen’s disease. Two years of treatment with dapsone, rifampin, and clofazimine and subsequent suppression with dapsone monotherapy led to resolution of the rash and improvement of numbness. Conclusion: This case illustrates the importance of considering Hansen’s disease in the differential diagnosis of rash and numbness, even in individuals who have never left the continental United States.