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Histoid leprosy: a prospective diagnostic study in 38 patients
1Department of Dermatology and Venereology, Maulana Azad Medical College, New Delhi, India.
Abstract:
Histoid leprosy is a fascinating expression of multibacillary leprosy, the incidence of which was 3.6%. It was seen predominantly in males of the younger age group, who were on inadequate and irregular dosage of diaminodiphenyl sulfone. Papules, cutaneous and/or subcutaneous nodules and plaques appearing over apparently normal skin were its exquisite prospective clinical features. It was invariably supported by enormous, uniformly solid staining discrete bacilli from the lesions, in contrast to their virtual absence from the surrounding normal-appearing skin. Encapsulated tumorous mass, formed primarily by spindle-shaped histocytes, displayed either in intertwining, criss-cross or whorled fashion in haematoxylin-eosin-stained sections, were supplementary. The morphology of acid-fast bacilli was, however, similar to skin-slit smears.
Insights
Histoid leprosy, a multibacillary form, presents as papules and nodules in younger males with irregular treatment. Diagnosis relies on identifying numerous bacilli in lesions, distinct from surrounding skin.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Histoid leprosy is a rare manifestation of multibacillary leprosy, accounting for 3.6% of cases.
- It predominantly affects younger males, often linked to inadequate treatment with diaminodiphenyl sulfone (DDS).
Purpose of the Study:
- To describe the clinical and histopathological features of histoid leprosy.
- To highlight diagnostic markers for histoid leprosy.
Main Methods:
- Clinical observation of patients with histoid leprosy.
- Dermatopathological examination of skin lesions, including H&E staining.
- Microscopic analysis of bacilli in skin smears and lesions.
Main Results:
- Key clinical features include papules, cutaneous/subcutaneous nodules, and plaques on seemingly normal skin.
- Lesions consistently show abundant, uniformly solid-staining bacilli, unlike surrounding skin.
- Histopathology reveals encapsulated tumorous masses of spindle-shaped histiocytes in various arrangements.
Conclusions:
- Histoid leprosy has distinct clinical and histopathological characteristics.
- The presence of numerous bacilli within lesions is a crucial diagnostic indicator.
- Morphology of acid-fast bacilli in lesions is similar to skin-slit smears.