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Histoid leprosy - unusual presentation.

S Pradeep Nair1, K Prasanna Moorthy, Sukumaran Suprakasan

  • 1Department of Dermatology and Venereology, Medical College Hospital, Trivandrum, Kerala, India. bijili@asianetindia.com

International Journal of Dermatology
|May 3, 2006
PubMed
Summary

This case highlights histoid leprosy, a rare form of lepromatous leprosy, presenting as skin papules and a chronic toe ulcer. Early diagnosis and multi-drug therapy are crucial for managing this nerve-damaging infection.

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Microbiology

Background:

  • Leprosy, a chronic infectious disease caused by Mycobacterium leprae, primarily affects the skin, peripheral nerves, and upper respiratory tract.
  • Histoid leprosy is a rare, distinct clinical variant of lepromatous leprosy characterized by nodular, tumor-like lesions.
  • Accurate diagnosis is essential for effective treatment and preventing nerve damage and disability.

Observation:

  • A 39-year-old male presented with a nonhealing toe ulcer and multiple skin-colored papules on the trunk and extremities.
  • Physical examination revealed multiple discrete papules, pedunculated tumor-like masses on the thigh, and a chronic ulcerated toe with sensory loss.
  • Nerve thickening was noted in bilateral greater auricular, ulnar, radial cutaneous, and common peroneal nerves.

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Findings:

  • Clinical diagnosis suggested histoid leprosy, with differential diagnoses including dermatofibroma, neurofibroma, and Kaposi's sarcoma.
  • Microbiological examination of ear lobe smears and skin lesions revealed a high bacterial index (BI) and morphological index (MI) for acid-fast bacilli.
  • Histopathological examination of skin biopsies confirmed lepromatous leprosy, histoid variant, with abundant acid-fast bacilli and foamy macrophages.

Implications:

  • This case underscores the importance of considering rare leprosy variants in the differential diagnosis of chronic skin lesions and neuropathies.
  • Prompt initiation of multi-drug therapy (dapsone, clofazimine, rifampicin, ofloxacin) is critical for successful treatment and preventing disease progression.
  • Increased awareness and diagnostic vigilance are necessary for early identification and management of histoid leprosy to mitigate long-term complications.