Coexistence of Mycobacterium Tuberculosis and Mycobacterium Leprae in a Patient- an Alarm of Inadequate Innate Immune Response?

Abstract

Mycobacterium tuberculosis (M.Tb) and Mycobacterium leprae (M.Leprae) are Gram-positive aerobic Acid-Fast Bacilli (AFB) causing chronic granulomatous infections like Tuberculosis (TB) and Leprosy respectively. They can present with varied manifestations according to the host’s immune status and response.^[1] Both are prevalent in clusters in developing countries; however, the simultaneous occurrence of both infections in an individual is rare even in endemic areas (0.02 per 100,000 population).^[2] Few case reports showing the coexistence of TB and leprosy, majority are TB developing following immunosuppressive treatment of leprosy reactions. Of which pure neuritic presentation of leprosy in an old treated case of Pulmonary Tuberculosis (PTB) has not been reported yet. Here we are reporting a case of PTB while on treatment developed neurological manifestations, diagnosed to be a case of poly neuritic leprosy (PNL). PNL is a rare form of leprosy, characterised by an area of sensory loss along the distribution of single/multiple thickened nerve trunks with or without motor deficit in the absence of skin lesions.

Keywords: TB with Pure Neuritic Hansen, SNP- PPTN22, Defective Lymphocyte Transformation, SNP- Granulomatous infection