Some comments about a case reported by Wade and Rodrigues In the 30's.

Abstract

WADE and RODRIGUES reported a leprosy case who was followed up during a period of eight years (1932-1940). Initially the patient was thought to be a minor tuberculoid that evolved rapidly and transformed into a major tuberculoid form. After a period of almost two years without manifestation of the disease he presented new and more severe reactional episodes which later become bullous. The case was considered borderline by its evolution, features of the lesions and bacterial findings. The author considered this case as a reactional one since the beginning and commented also its evolution and clinical and bacteriological aspects. He called attention to the regression of the lesions and the disappearance of bacilli without therapeutic influence and later the occurrence of new outbreaks and reappearance of bacilli, even after a large period of time. This report permitted to elaborate an hypothesis in which the bacilli in reactional borderline cases disappear in most part due to the action of the immune system of the host in contrast with reactional tuberculoid cases in which there is a total destruction of bacilli, therefore, the new outbreaks are caused by multiplication of persisters. Confirmation of this hypothesis could have therapeutic implications. MDT/ WHO would be unable to prevent new reactional episodes since the bacterial multiplication occurs out of the period of drug activity. If so, reversal reaction that occur after treatment could actually be a relapse and the best option for the treatment would be to give drugs every day or in short intervals until the appearance of a new acute episode. The author also emphasize the amount of knowledge one can acquire with the study of well documented cases reported by early researchers.