Leprosy in Pregnancy: A Case Series in 4 Dermatology Clinics in Malaysia

ABSTRACT

IntroductionManagement of leprosy in pregnancy is challenging. Here we aim to describe the clinical characteristicsand the management of leprosy in pregnancy.MethodsThis is a retrospective study on pregnant women with leprosy managed in the Department ofDermatology in Hospital Kuala Lumpur, Hospital Pulau Pinang, Hospital Sultanah Bahiyah andHospital Queen Elizabeth between 1994 and 2015.ResultsThere were ten patients with 12 pregnancies with a median age of 27.5 years (range 16-33). Fivewere foreigners. There were four cases of lepromatous leprosy, two cases of borderline lepromatous,two cases borderline tuberculoid leprosy and one case each for tuberculoid and mid borderline leprosy.Seven pregnancies (58%) were documented to have reactions. Four reversal reactions (33%), threeerythema nodusom leprosum (25%) and two Lucio’s phenomenon (17%) were documented. Bothpatients with Lucio’s phenomenon had undiagnosed leprosy and presented with preterm labour,anemia, oligohydramnios and intrauterine growth restriction. Mortality was recorded in one patientdue to dapsone induced hypersensitivity syndrome complicated with septicaemia. All patients wereprescribed multidrug therapy but in three pregnancies, the patients chose to defer the treatment. Therewas a spontaneous miscarriage at second trimester and a case of early neonatal death. The neonatalcomplications recorded for the 10 live deliveries were low birth weight, jaundice and clofazimineinducedhyperpigmentation.ConclusionThe majority of our patients with leprosy had complications throughout the pregnancies. Earlydetection and prompt treatment can prevent unfavorable fetal outcome & threatened maternal health.