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Multibacillary leprosy: erythema as the only clinical presentation
1Department of Dermatovenereology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Chinese Medical Journal
|April 12, 2012
Summary
Two patients with unusual skin rashes were initially misdiagnosed. Skin biopsies revealed multibacillary leprosy, highlighting the need for vigilance in diagnosing this infectious disease.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Leprosy, a chronic granulomatous infection caused by Mycobacterium leprae, primarily affects the skin and peripheral nerves.
- Despite being preventable and curable, leprosy remains endemic in certain regions, posing a public health challenge.
Observation:
- Two patients presented with asymptomatic, irregular erythematous lesions on their trunk and extremities.
- Initial clinical diagnosis considered mycosis fungoides and livedo reticularis due to the absence of typical leprosy symptoms like nerve damage and known exposure.
Findings:
- Dermal biopsies revealed perineural and periadnexal foamy-cell granulomas.
- Fite staining identified a significant presence of acid-fast bacilli, confirming Mycobacterium leprae infection.
- A final diagnosis of multibacillary leprosy was established based on histopathological and microbiological evidence.
Implications:
- These cases underscore the importance of considering leprosy in differential diagnoses, even with atypical presentations.
- Dermatologists must maintain a high index of suspicion for leprosy, especially in endemic areas.
- Skin biopsy and specialized staining are crucial for accurate diagnosis of unusual leprosy manifestations.
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