Virchowian leprosy: consequences of a neglected disease – a case report

Abstract

Introduction: leprosy is a chronic infection caused by Mycobacterium leprae, with a predilection for skin and peripheral nerves. Brazil ranks second worldwide in the number of cases, with a proportional increase in multibacillary forms, indicating delayed diagnoses. Objective: to report a case of virchowian leprosy with type 2 lepra reaction and late diagnosis, highlighting the importance of early clinical suspicion and professional training. Case description: a 74-year old man presented with asthenia, edema, weakness, and paresthesias for five years. He had four hospital admissions in 2024 without a conclusive diagnosis. Progressed with fever and ulcerated nodular lesions. Physical examination showed facial infiltration, madarosis, ichthyosis, gynecomastia, and anesthetic skin lesions. Neurological exam revealed claw hands and foot drop. Skin biopsy revealed xanthomatous histiocytes and a bacilloscopic index of 4+/5+, confirming multibacillary virchowian leprosy associated with necrotizing erythema nodosum leprosum (ENL). Corticosteroid therapy was initiated with clinical improvement, and the patient was referred for multidrug therapy and contact tracing. Discussion: despite presenting typical signs, the diagnosis occurred five years after symptom onset, resulting in physical and psychosocial sequelae. Underdiagnosis reflects limited clinical suspicion and systemic failures. Tools such as the Leprosy Suspicion Questionnaire can aid in early detection. Final considerations: this case highlights the consequences of delayed diagnosis and reinforces the need for healthcare professional training and early screening strategies to prevent disabilities and reduce disease transmission.