Lepromatous leprosy: An Unusual Presentation.

Area of Science:

• Dermatology
• Infectious Diseases
• Urology

Background:

• Leprosy, a chronic infectious disease caused by Mycobacterium leprae, primarily affects the skin, peripheral nerves, and upper respiratory tract.
• Genitourinary manifestations of leprosy are rare but can occur, particularly in lepromatous leprosy.
• Early diagnosis and treatment are crucial to prevent severe complications and disability.

Observation:

• A 25-year-old male presented with sensory loss in hands and feet and urinary difficulties.
• Physical examination revealed an indurated sclerotic plaque on the penis and scrotum, alongside other signs of lepromatous leprosy.
• Skin biopsy of the penile lesion demonstrated a high bacterial load (BI 6+) of acid-fast bacilli extending into the epidermis.

Findings:

• Histopathology of the penile lesion showed an absence of the Grenz zone, a characteristic feature of leprosy.
• Foamy macrophages were present in the dermis, extending to the dermo-epidermal junction, indicative of lipid-laden macrophages involved in the immune response to M. leprae.
• The findings confirm lepromatous leprosy with unusual genital involvement.

Implications:

• This case underscores the potential for leprosy to manifest with genital lesions, challenging typical clinical presentations.
• It emphasizes the need for a high index of suspicion for leprosy in patients presenting with unexplained genital plaques and neurological symptoms.
• Comprehensive evaluation, including skin biopsy, is essential for accurate diagnosis and appropriate management of atypical leprosy cases.