Emergence of Mycobacterium leprae Rifampin Resistance Evaluated by Whole-Genome Sequencing after 48 Years of Irregular Treatment

A case of Mycobacterium leprae rifampin resistance after irregular antile- prosy treatments since 1971 is reported. Whole-genome sequencing from four longi- tudinal samples indicated relapse due to acquired rifampin resistance and not to re- infection with another strain. A putative compensatory mutation in rpoC was also detected. Clinical improvement was achieved using an alternative therapy.