Neuraxial labor analgesia in a pregnant patient with leprosy: a case report.

BACKGROUND: Leprosy is an infection caused by Mycobacterium leprae complex that primarily affects the skin and peripheral nerves but may also involve multiple organ systems. Although globally endemic, the disease is rare in high-income countries, and leprosy during pregnancy is infrequently reported. Immunologic adaptations of pregnancy may precipitate disease onset or exacerbate reactional states, which can complicate anesthetic management. Literature on obstetric neuraxial labor analgesia in women with leprosy is limited, with no previously documented reports describing its use during labor.

CASE DESCRIPTION: Written informed consent was obtained. A 37-year-old multiparous woman with multibacillary (lepromatous) leprosy was scheduled for induction of labor at 38 weeks for preeclampsia. She was receiving multidrug therapy with dapsone, rifampicin, and moxifloxacin. At the patient's request, labor analgesia was provided with a dural puncture epidural at L4-L5. The lumbar puncture site was free of cutaneous lesions, and neurologic examinations were normal. Analgesia was satisfactory and delivery was uncomplicated; neurologic status was unchanged at discharge and at one-year follow-up.

DISCUSSION: This case illustrates the successful use of neuraxial labor analgesia in a patient with multibacillary leprosy on multidrug therapy. Pre-procedure neurologic assessment, exclusion of lumbar spine lesions, and awareness of potential autonomic dysfunction are critical. This report underscores the need for careful multidisciplinary coordination and individualized anesthetic planning to provide neuraxial labor analgesia in parturients with leprosy.