Borderline lepromatous leprosy presenting as a single cutaneous plaque

Area of Science:

• Dermatology and infectious diseases, focusing on leprosy.
• Clinical immunology and reactional states in leprosy.

Background:

• Leprosy diagnosis can be challenging, with initial clinical presentation sometimes differing from histopathological findings.
• Tuberculoid leprosy and borderline lepromatous leprosy represent different points on the leprosy spectrum, influencing treatment and prognosis.

Observation:

• A 38-year-old Indonesian man presented with a solitary anesthetic plaque, initially suggestive of tuberculoid leprosy.
• Histopathology revealed borderline lepromatous leprosy, prompting multidrug therapy for multibacillary disease.
• Seven months into treatment, the patient developed tumid lesions and new plaques, indicative of a reversal reaction (type 1).

Findings:

• The case highlights the potential for diagnostic discrepancies between clinical presentation and histopathology in leprosy.
• The development of a type 1 reversal reaction during treatment for multibacillary leprosy was observed.
• The reaction was successfully managed with the addition of prednisone.

Implications:

• This case underscores the importance of integrating clinical, histopathological, and immunological data for accurate leprosy diagnosis and management.
• Understanding and timely management of leprosy reactions are crucial for preventing further nerve damage and disability.
• The study contributes to the knowledge of leprosy spectrum variations and reactional states in clinical practice.