Histoid Leprosy Presenting with Keloid Like Lesions

Area of Science:

• Dermatology
• Infectious Diseases
• Microbiology

Background:

• Leprosy, a chronic infectious disease caused by Mycobacterium leprae, typically manifests with various cutaneous and neurological symptoms.
• Histoid leprosy is a rare form characterized by nodular lesions resembling xanthoma or keloid, often associated with high bacterial loads.

Observation:

• A 42-year-old male presented with multiple, firm, hyperpigmented papules and plaques on his posterior trunk, clinically mimicking keloid.
• The patient also exhibited skin-colored papules on the anterior trunk and face, glove and stocking anesthesia, and thickened peripheral nerve trunks.
• Slit skin smears from earlobes, lesions, and normal skin were positive for Mycobacterium leprae.

Findings:

• Skin biopsy revealed a dense collection of spindle-shaped histiocytes laden with acid-fast bacilli in the dermis.
• The histopathological findings, combined with clinical presentation and smear results, confirmed the diagnosis of histoid leprosy.
• The keloid-like appearance of the lesions represents a highly unusual manifestation of this leprosy subtype.

Implications:

• This case highlights the diverse and sometimes atypical clinical presentations of histoid leprosy.
• Recognizing such rare presentations is crucial for timely diagnosis and effective management of leprosy.
• Further research into the pathogenesis of varied histoid leprosy manifestations may improve diagnostic criteria and treatment strategies.