抗酸性染色陰性的寡菌型邊緣性結核型漢生病：病例報告

Case Report: Paucibacillus Borderline-Tuberculoid Leprosy with Negative Acid-Fast Stain

麻風分支桿菌，於1873年由挪威醫師Gerhard Armauer Hansen確認是造成漢生病的致病因子。依據不同宿主本身免疫狀況以及所帶菌株量，所造成的皮膚病灶以及周邊神經缺損呈現多樣化的臨床表現。至今，漢生病仍是一個重要的全球性衛生問題，特別是在中非、印度、巴西以及東南亞地區。儘管透過根除計畫的執行以及世界衛生組織多重藥物合併療法(WHO-MDT)投予，漢生病的盛行率有了大幅度的下降，但仍有許多未解決的問題，包括不明確的傳播途徑、缺少方便精確的診斷工具以及正確統一的診斷分類準則等。此病例報告中所提及的病患，初始表現是右前臂有一個持續三年、局部感覺遲鈍的紅色斑塊，診斷為真菌感染以及接觸性皮膚炎，至十天前，在他的背部、臉部以及雙手前臂出現結節丘疹，神經學檢查出現三叉神經的第一分支皮區觸覺反應減低，最終依據切片及臨床表現診斷為邊緣性結核型漢生病。本文的目的，希望能藉此病例提醒基層醫師，在面對特殊皮膚及神經學變化時，不要忽略了漢生病的可能性，應仔細評估，安排適當的檢查，必要時予以轉介，以期能早期診斷、早期治療，以防止造成永久性殘疾。

Mycobacterium leprae, identified by Norwegian physician Gerhard Armauer Hansen in 1873, is the causative agent of Leprosy. The host cell-mediated immunity and bacterial load determine the manifestations of skin lesion and the impairment of nerve injury. To date, leprosy remains an important health problem worldwide, especially in Central Africa, India, Brazil, and South-East Asia. While the implementation of the national elimination program and World Health Organization multi-drug therapy (WHO-MDT) does help curb the prevalence of leprosy, several crucial issues stay unresolved, notably the need to better identify the modes of transmission of leprosy, the development of convenient and precise diagnostic tools, and the introduction of accurate diagnostic criteria. The patient in our case reported a large single, erythematous, well defined anaesthetic lesion on his right forearm, which has been present for 3 years, and multiple nontender nodules located in his bilateral forearm, back of the trunk and face for 10 days. The dermatome of the 1st branch of the 5th cranial nerve showed decreased response to tactile sensation. Final clinical diagnosis was borderlinetuberculoid leprosy after biopsy but he was initially misdiagnosed and treated for fungal infections or contact dermatitis. This case illustrates the importance of prompt diagnosis and treatment of Hansen disease to prevent permanent disability.