Abstract：
Leprosy, caused by Mycobacterium leprae (M. leprae), primarily manifests with cutaneous and peripheral nerve involvement. Systemic involvement, particularly in the bone marrow, is exceedingly rare. This report presents a case of lepromatous leprosy with bone marrow involvement, emphasizing the systemic nature of the disease and the importance of comprehensive diagnostic and management approaches. We aim to present a case of lepromatous leprosy with bone marrow involvement, detailing the clinical presentation, diagnostic evaluation, and management approach. A 65-year-old male with lepromatous leprosy and severe erythema nodosum leprosum developed pancytopenia. After undergoing comprehensive clinical evaluation, including history taking, physical examination, and laboratory investigations, bone marrow examination and molecular diagnostics using polymerase chain reaction (PCR) were performed to confirm the presence of M. leprae as an etiology for his pancytopenia. The bone marrow aspirate revealed hypercellularity with erythropoiesis and thrombopoiesis within normal limits. Foamy histiocytes with erythrophagocytosis were observed, along with the presence of M. leprae on Modified Ziehl-Neelsen stain. Molecular analysis confirmed M. leprae DNA in the bone marrow aspirate. Treatment with multi-drug therapy (MDT) and thalidomide resulted in normalization of blood counts and healing of skin lesions. This case underscores the systemic nature of leprosy and the rarity of bone marrow involvement, highlighting the importance of thorough evaluation in cases of persistent symptoms. Comprehensive diagnostic approaches, including bone marrow examination and molecular diagnostics, are essential for accurate diagnosis and timely initiation of appropriate treatment, ultimately improving patient outcomes and minimizing disease complications.
摘要：
麻风病,由麻风分枝杆菌(M.麻风),主要表现为皮肤和周围神经受累。系统性参与，特别是在骨髓中，非常罕见。本报告介绍了一例骨髓受累的麻风病，强调疾病的系统性以及全面诊断和管理方法的重要性。我们的目的是介绍一例骨髓受累的麻风病，详细介绍临床表现，诊断评估,和管理方法。一名65岁的男性患有麻风病和严重的结节性麻风红斑，出现全血细胞减少症。经过全面的临床评估，包括历史，体检,和实验室调查，使用聚合酶链反应(PCR)进行骨髓检查和分子诊断,以确认麻风分枝杆菌的存在是其全血细胞减少症的病因.骨髓抽吸物显示细胞增多，红细胞生成和血小板生成在正常范围内。观察到有红吞噬作用的泡沫组织细胞，以及改良的Ziehl-Neelsen染色上麻风分枝杆菌的存在。分子分析证实了骨髓抽出物中的麻风分枝杆菌DNA。多药治疗（MDT）和沙利度胺的治疗导致血细胞计数正常化和皮肤病变的愈合。该病例强调了麻风病的系统性和骨髓受累的罕见性，强调在持续症状的情况下进行彻底评估的重要性。全面的诊断方法，包括骨髓检查和分子诊断，对于准确诊断和及时开始适当治疗至关重要，最终改善患者预后并最大限度地减少疾病并发症。
