Ulcerating lepromatous leprosy in a patient with dapsone-resistant Mycobacterium leprae.

While u nder treatment with'dapso ne for lepromatous leprosy , a 5 0-year-old male Greek Cypriot presented with multiple widespread lesions of a bizarre type, many of them freely ulceTating. Iinically and histologically, peripheral nerves were little affected, but biopsy s mples of skin and ulcers contained enormous numbers of leprosy bacilli. M ouse footpad inoculation of the bacilli from skin homogenates showed resistance to all three levels of d apsone tested , namely 0 .0 1 ,0 .00 I and 0 .000 I % in the diet of mice ..... From two of the larger u lcers bacilliferous discharges were collected in occlusive dre'ssings over a 2 4-h period . Attention is drawn to the very large nu mber of bacilli cou nted in this discharge . Excluding the nose, the shedding of dapsone-resistant bacilli into the environment from body ulcers in this case could have been in excess o f 20 millions d ai ly.