Relapse of Multibacillary Leprosy Treated with Rifampicin and Ofloxacin: A Case Report

Introduction: Despite the dramatic success of the MDT by WHO regimens, a newer generation such as Ofloxacin displayed very promising bactericidal activity and in combination with Rifampicin by far is the highly bactericidal drug against M. leprae.Case summary: A 38 year old Javanese man presented with relapsed leprosy after a 14 month course of WHO MDT. He complained persisted lesions all over his body lasting 1 year and several well demarcated erythematous and hyperpigmented plaques were observed. There were sensory impairment on some lesions and thickening of nerve on extremities. Leprosy was diagnosed in 2014 and after he completed WHO-MDT for 1 year, his BI was found to be 3+ and MI of 10%. A skin biopsy revealed borderline lepromatous and upgrading reaction. He was started on re-treatment MBMDT for two months but lesions persist and skin smear increased, showed a BI 5+ with MI of 60%. He was commenced on daily 600 mg rifampicin, 400 mg ofloxacin and 500 mg aspirin three times daily for six months. The patient completed the treatment and his lesions regressed. Conclusion: This case highlights therapeutic efficacy of Rifampicin and Ofloxacin in producing clinical improvement and bacterial killing. Additionally it resurrects the use of aspirin to treat type 1 reaction.Introduction: Despite the dramatic success of the MDT by WHO regimens, a newer generation such as Ofloxacin displayed very promising bactericidal activity and in combination with Rifampicin by far is the highly bactericidal drug against M. leprae. Case summary: A 38 year old Javanese man presented with relapsed leprosy after a 14 month course of WHO MDT. He complained persisted lesions all over his body lasting 1 year and several well demarcated erythematous and hyperpigmented plaques were observed. There were sensory impairment on some lesions and thickening of nerve on extremities. Leprosy was diagnosed in 2014 and after he completed WHO-MDT for 1 year, his BI was found to be 3+ and MI of 10%. A skin biopsy revealed borderline lepromatous and upgrading reaction. He was started on re-treatment MBMDT for two months but lesions persist and skin smear increased, showed a BI 5+ with MI of 60%. He was commenced on daily 600 mg rifampicin, 400 mg ofloxacin and 500 mg aspirin three times daily for six months. The patient completed the treatment and his lesions regressed.Conclusion: This case highlights therapeutic efficacy of Rifampicin and Ofloxacin in producing clinical improvement and bacterial killing. Additionally it resurrects the use of aspirin to treat type 1 reaction.