Leprosy, Type 2 Diabetes, and Peripheral Neuropathy: A Complex Case of Diabetic Foot Ulcer

Abstract

Background: Peripheral neuropathy is a significant factor in the development of neuropathic foot ulcers, commonly associated with conditions like type 2 diabetes mellitus and leprosy. These ulcers often result from sustained pressure at localized points, compounded by compromised circulation and delayed wound healing. Leprosy, though uncommon, should be considered in the differential diagnosis of neuropathic ulcers, especially in endemic areas.

Case Presentation: An 80-year-old male with a history of type 2 diabetes mellitus, hypertension, ischemic heart disease, and newly diagnosed leprosy presented with a diabetic foot ulcer. The ulcer had been present for 3 months following nail trauma. Clinical examination revealed a BMI of 24.67 kg/m², bilateral ankle-brachial pressure index (ABPI) of 2.5, and a Vibratory Perception Threshold (VPT) of 50. Angiography showed significant atherosclerotic disease, and the patient underwent angioplasty of stenotic segments in the peroneal artery. Despite Charcot foot deformity on radiography, surgery was not required at this early stage.

Management: The patient was treated with a basal-bolus insulin regimen for strict diabetes control, along with broad-spectrum antibiotics (oral clindamycin and ciprofloxacin). Wound debridement and dressing changes were performed daily. After 4 weeks of antibiotic therapy, moxifloxacin continued for 2 weeks. During treatment, the patient developed hypopigmented lesions, leading to a diagnosis of indeterminate leprosy. Multi-drug therapy (rifampicin, dapsone, clofazimine) was initiated.The diabetic foot ulcer healed within 8 weeks with proper treatment and offloading.

Conclusion: This case underscores the importance of considering leprosy in the differential diagnosis of neuropathic foot ulcers, especially in endemic regions. Effective management, including glycemic control, wound care, and multi-drug therapy, is essential to prevent complications and promote healing.

How to cite this: Suhail Z, Askari S. Leprosy, Type 2 Diabetes, and Peripheral Neuropathy: A Complex Case of Diabetic Foot Ulcer. JPES. 2024;1(2):87-90.