Late reversal reaction with resistant Mycobacterium leprae: an emerging paradigm.

While Type 1 reaction is seen in leprosy patients, in up to 30% of patients, late reaction is uncommon and usually is seen in the first two years of release from treatment (RFT). It is believed that these reactions are consequent to dead bacilli and the World Health Organization recommends treatment with steroids without multidrug therapy (MDT; with the proviso of adding clofazimine only when steroid therapy exceeds four months duration). A few studies, though, have noted live bacilli present in reversal reactions and hence recommend concomitant MDT. We report a case of resistant bacilli in late reaction and discuss the implications of this finding.