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Leprosy: a diagnostic trap for dermatopathologists in nonendemic area
Franco Rongioletti1, Rosella Gallo, Emanuele Cozzani
1Section of Dermatology, DISEM, Department of Pathology, University of Genoa, Genoa, Italy. franco.rongioletti@unige.it
The American Journal of Dermatopathology
|July 11, 2009
Summary
Diagnosing leprosy can be challenging, especially in non-endemic areas. This case highlights the importance of clinicopathological correlation for accurate leprosy diagnosis when initial findings are discordant.
Area of Science:
- Dermatology
- Infectious Diseases
- Pathology
Background:
- Leprosy, caused by Mycobacterium leprae, presents diverse clinicopathological forms.
- Diagnosis is challenging in non-endemic regions, often complicated by clinical-histopathological discordance.
Observation:
- A 43-year-old woman in Italy (non-endemic) presented with an annular lesion.
- Initial histopathology showed a moderate dermal infiltrate (lymphocytes, histiocytes) without granulomas or foamy cells.
- Clinical suspicion was absent initially.
Findings:
- Clinicopathological correlation, considering family history, Brazilian origin, and anesthetic lesions, raised suspicion for leprosy.
- Further review revealed perineural lymphohistiocytic infiltrate and rare bacilli, suggesting indeterminate leprosy.
- Clinical features and limited bacilli favored borderline leprosy, indicating diagnostic discordance.
Implications:
- This case underscores the diagnostic challenges of leprosy in non-endemic settings.
- Emphasizes the critical role of integrating clinical, epidemiological, and histopathological data for accurate leprosy classification.
- Highlights the potential for misdiagnosis due to discordant findings between clinical presentation and histopathology.
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