INTERNATIONAL JOURNAL OF LEPROSY ^ Volume 55, Number 3 Printed in the' Autopsy Findings in 35 Cases of Leprosy in Malaysia' Pailoor Jayalakshmi, Lai Meng Looi, Kuan Joo Lim, and Krishnan Rajogopalan 2 Leprosy is still a public health problem in Malaysia, although the incidence is grad- ually declining. On the basis of data in the Registry of the National Leprosy Control Centre, the incidence is estimated to be about 4 per 100,000 population. Papers on leprosy from Malaysia have concentrated on the epidemiology, clinical manifesta- tions and response to therapy. However, there is no study based on autopsy findings. The purpose of this paper is to highlight the pathological findings observed at autopsy on leprosy patients and to consider their clinical significance. MATERIALS AND METHODS During the 5-year period between Janu- ary 1981 and December 1985, autopsies were performed on 35 leprosy patients in the University Hospital, Kuala Lumpur. The subjects in this study were inmates of the leprosarium at the National Leprosy Con- trol Centre, Sungai 13uluh, Selangor. Mainly unclaimed bodies from the leprosarium were sent for post-mortem examination. At au- topsy the gross findings were noted. Rep- resentative sections from the major organs, including normal and abnormal areas, were fixed in 4% buffered formaldehyde and embedded in paraffin. Sections were rou- tinely stained with hematoxylin and eosin (H&E). Sections from the skin, nerve, liver, spleen, kidney and adrenals were stained by Fite's modification of the Ziehl-Neelsen stain for the detection of Mycobacterium ' Received for publication on 10 November 1986; accepted for publication in revised form on II Feb- ruary 1987. = P. Jayalakshmi, M.R.C.Path., Lecturer, and L. M. Looi, M.R.C.Path., M.R.C.P.A., Professor, Depart- ment of Pathology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia. K. J. Lim, M.P.H., Deputy Director, and K. Rajagopalan, F.R.C.P., Director, National Leprosy Control Centre, Sungai Buluh, Selangor, Malaysia. Reprint requests to Dr. Jayalakshmi. lq,rae. In addition, sections from at least one and frequently all of four organs, i.e., the heart, kidney, liver, and spleen, were stained with alkaline Congo red and ex- amined for the presence of amyloid. Amy- loid was defined according to the accepted histological criteria of Congophilia with green birefringence under cross-polarized light. All paraffin blocks of positive cases were further sectioned and stained with Congo red, and the extent of amyloid in- volvement was studied. Clinical data was obtained from case records. The classifica- tion of leprosy was based on clinical find- ings, skin smears and/or skin biopsies per- formed previously. Tuberculoid leprosy included the categories of borderline tu- berculoid and polar tuberculoid leprosy. Similarly, lepromatous leprosy included borderline lepromatous and polar lepro- matous cases. Statistical analysis of the au- topsy data was done using the Chi-squared test. RESULTS The ages of the patients at death ranged from 52 to 92 years with a mean age of 74 years. Thirty patients were Chinese and five were Indians. The majority (31) of patients were males. The clinical duration of the dis- ease varied from 10 to 30 years. Twenty- three (66%) patients had lepromatous lep- rosy and 12 (34%) had tuberculoid leprosy. Infections. Infections were common find- ings in this study. Pyogenic bronchopneu- monia was seen in 12 (34%) cases and was the cause of death in six (17%) cases. Two patients had septicemia, one of whom had ascending cholangitis while the other de- veloped a brain abscess. Nonspecific colitis with dehydration was noted in three pa- tients. The prevalence of pulmonary tuber- culosis was high, being detected in 10 (28%) cases, 3 of whom had caseating granulomata and 2 showed tuberculous bronchopneu- 510