56^ International Journal of Leprosy^ 1998

The number of patients and deaths in thisstudy was small, and therefore the resultsshould be interpreted with caution.

—Jacques van den Broek, M.D., M.P.H.National Tuberculosis and

Leprosy ProgrammeP.O. Box 5478Dar es Salaam, TanzaniaRoyal Tropical InstituteWibautstraat 137.11097 DN Amsterdam, The Netherlands

Sayoki Mfinanga, M.D.National Institute of Medical ResearchMuhimbili Research Station and

Central "Tuberculosis LaboratoryP.O. Box 3436Dar es Salaam, Tanzania

—Candida Moshiro, M.Sc.Department of Epidemiology

and BiostatisticsUniversity of Dar es SalaamP.O. Box 65001Dar es Salaam, Tanzania

Richard O'Brien, M.D.Tuberculosis UnitWorld Health OrganizationGeneva, SwitzerlandDivision of TB EliminationCenters for Disease Control

and PreventionAtlanta, Georcia 30333, U.S.A.

—Arbogast MugomelaLaboratory TechnicianBugando Medical CentreP.O. Box 1370Mwanza, Tanzania

Reprint requests to J. van den Broek, VanOmmerenstraat 16, 5708 KB Helmond, TheNetherlands.

REFERENCES1. BORGDORFF, M., VAN DEN BROEK, J.. CHIN% H..

KL0KKE, H., GRAF, P., BARONGO, L. R. andNEwEl.l., J. N. IIV-1 infection as a risk factor forleprosy; a case-control study in Tanzania. Int. J.Lepr. 61 (1993) 556-562.

2. BwiRE, R. and KAWUNIA, 11. J. Type 1 reactions inleprosy, neuritis and steroid therapy: the impact ofthe human immunodeficiency virus. Trans. R. Soc.Trop. Med. Hyg. 88 (1994) 315-316.

3. Ci RINI, II. J., O'BRIEN, R. J., Ci ioNDE, T. M., GRAF,

P. and RIEDER, H. L. An epidemiological study oftuberculosis and 111V infection in Tanzania, 1991-1993. AIDS 10 (1996) 299-309.

4. DE ALNIEIDA, A. M., FERREiRA RosEoNo, A. M. andTiRAfioscin Foss, N. Leprosy and HIV infection.(Letter) Int. J. Lepr. 62 (1994) 133-135.

5. KAsfiALA, 0., MARLINK, R., ILuNGA, M., Dust:, M.,GoRmtis, B., XII, K., MUKERA, P., KAsoNco, K. andEssEx, M. Infection with human immunodefi-ciency virus type I (I IIV-1) and human T cell lym-photropic viruses among leprosy patients and con-tacts: correlation between 111V-1 cross reactivityand antibodies to lipoarabinomannan. J. Infect. Dis.169 (1994) 296-304.

6. OovAREs, 1.. N1., PIZZARIE1.1.0, G. E. A., BENEi000,J. and FARINA, M. H. Lepromatous leprosy andHIV infection. (Letter) Int. J. Lepr. 62 (1994)295-296.

7. OREGE, P. A., ODAwA, B. A., OF:Eno, C. M.,

OBURA, M., OKUM P., AmiNio, R. K. and WERE,M. The effect of 111V infection on clinical re-sponse of leprosy patients to multiple drug therapyin Kenya. (Abstract) Int. J. Lepr. 61 (1993) 37A.

8. VAN DEN BRONK, J.. MrINAGA, S., Mosmo, C.,O'BR[EN, R., MmoNiELA, A. and LED, M. Impactof HIV infection on the outcome of treatment andsurvival of tuberculosis patients in Mwanza, Tanza-nia. Int. J. Tuberc. Lung Dis. (accepted for publica-tion 1997).

Relapse of Multibacillary Leprosy after Rifampin andOfloxacin Treatment for 28 Days; a Case Report

TO THE EDITOR:

We report here on what we believe to bethe first case of relapse in multibacillary(MB) leprosy following short-coursechemotherapy for 28 days with daily doses

of rifampin (R) 600 mg and ofloxacin (0)400 mg.

The following diagram summarizes thetime sequence of events relating to a previ-ously untreated, 30-year-old, male BL-LLpatient with an initial bacterial index (BI) of

I^I ^RI GRISSION 01 RI 1 APS1.1 I I tiIONS All UR III :'I RI Al MI N ir 2

4AT RELAPSE 1.1ER 6 VVE1:1(9

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RO-28 days

1^4

66, 1^ Correspondence^ 57

THE I u,t1 RI .^Regression of relapsed lesions alter rctreatilictil.

4.6+ who received treatment with the ROregimen from 27 December 1990 to 22 Jan-uary 1991. The BI showed a gradual de-cline accompanied by clinical regression.The patient remained negative and sign freefrom 11 September 1995 ( 1 • 2 ). Relapse of

BL/LL lesions were noticed on 21 February1997 with a mean BI of 1.3+. The case isunder investigation for Mycobacterium lep-rae viability by mouse foot pad and drugsensitivity, etc.; the outcome is awaited.The patient was HIV negative.

The patient was treated with the sameregimen of RO for 28 days under supervi-sion. and the relapsed clinical lesions areregressing (Figs. 1-4). Currently, the B1 is1.3+. The satisfactory response to the sameregimen so far indicates the possibility of"persisters" as the cause of relapse and notresistance to the drugs employed. The pa-tient is under continuous observation.

All of the remaining 55 MB patients witha mean BI of >3+ included in the RO trialhave reached a state of skin-smear negativ-ity over a period of 6 years. None of themhas relapsed.

—Dr. R. GanapatiDr. V. V. Pai

Dr. C. R. RevankarS. Kingsley

Dr. H. 0. BulchandBombay Leprosy ProjectII IN Perm' MargSion-ChunabhaniMumbai -100 022, India

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58^ International Journal of Leprosy^ 1998

REFERENCESGANARCrI. R. Leprosy—LI Glimpse at the Changing

Scenario. Bombay: Acworth Leprosy I lospital Soci-ety for Research, Rehabilitation and Education inLeprosy and Bombay Leprosy Project, 1996, p. 30.

2. GANAPATI, R., PAI, V. V., ScuRoFF, II. J. and GAN-liEwAR, K. I,. Rate of decline in bacterial index inleprosy: observations after three different chemo-therapeutic interventions. (Letter) Int. 1. Lepr. 65( 1997) 264-266.

Abnormal Capillary Proliferation in the Irisof a Leprosy Patient

TO TI IF. EDITOR:

A 63-year-old, male lepromatous leprosypatient presented with decreased vision inboth eyes. He had received dapsone mono-therapy for 20 years. He was clinically in-active and his skin smears were negative foracid-fast bacilli (AFB).

In 1994 the patient's right eye was oper-ated on for cataract. At that time the righteye had a visual acuity of counting fingers,a weak orbicularis oculi muscle withoutdemonstrable lagophthalmos, iris atrophy, amiotic pupil with posterior synechia and anintraocular pressure of 17 mmHg. Duringcataract extraction there was posterior cap-sular rupture and vitreous loss. Postopera-tive recovery was prolonged due to persis-tent uvcitis requiring extended treatmentwith topical steroids, mydriatics and in-creased doses of clofazimine.

In November 1996 his right eye visionwas still only counting fingers and his lefteye vision had deteriorated to only percep-tion of light. There was no acute inflamma-tion in either eye. The left eye had had iri-docyclitis in October 1994 which wastreated with topical steroids and mydriaticsand took a long time to resolve. There wasweakness of the orbieularis oculi musclewithout obvious lagophthalmos. Iris atro-phy and posterior synechia were present.Since there was no acute inflammation inthe left eye and no useful vision in the righteye, cataract extraction was done on the lefteye. An extracapsular extraction was plannedbut was converted into an intracapsular ex-traction due to ruptured zonules. A largesector iridectomy was done and sent for his-topathological examination. The vitreousface was left intact. At the close of surgerythere was a large intraoperative hyphemawhich occupied 50% of the anterior cham-

ber even after 5 days postoperatively. Theaqueous above it developed a xantho-chromic appearance. A month later the hy-phema had resolved but iridocyclitis flaredup in the right eye and had to be treatedwith topical steroids and mydriatics. An ex-amination of the left eye done in April 1997showed a fibrinous layer and adhesionscovering the area of the sector iridectomy.The visual acuity was hand movements.The iris looked atrophic but had no rubiosisor abnormal vasculature.

The iris specimen sent for histopatho-logical examination showed focal and dif-fuse infiltration of the stroma with lympho-cytes, plasma cells and pigmented macro-phages. The constrictor pupillae musclewas infiltrated with inflammatory cells, andthere was muscle destruction. There wasalso an unusual proliferation of thin-walledcapillaries involving the entire tissue (Fig.1). However, in areas there were a fewthick-walled hyalinized blood vessels whichare normally present in the iris (Fig. 2).Some of these blood vessels showed mar-

FIG. I. Photomicrograph showing proliferatingthin-walled capillaries of varying sizes lined by en-dothelium (H&E x200).