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De novo histoid leprosy.

Kantaria SM - Indian Dermatol Online J (2014)

View Article: PubMed Central - PubMed

Affiliation: Consultant Dermatologist, Kantaria Skin Clinic, Porbandar, Gujarat, India.

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Histoid leprosy is a rare form of multibacillary (MB) leprosy with unique clinical and histopathological features... One week before, he had two episodes of epistaxis... On examination, multiple skin-colored, dome-shaped, non-tender nodules varying in size from 0.5 to 2 cm were found over the abdomen, back and both the upper and the lower limbs, more over the thighs [Figure 1] and knees [Figure 2]... There was partial claw hand [Figure 3] affecting four fingers of the right hand... Right ulnar nerve was thickened... Excisional biopsy from a firm nodule on abdomen showed a focally atrophied epidermis, beneath which the dermis was seen to contain a large circumscribed cellular infiltrate consisting of round-polyhedral foamy histocytes with vacuolated cytoplasm, and a fair number of plump spindle cells resembling fibroblasts, arranged randomly or in a whorl pattern [Figures 4 and 5]... The patient was placed on MB MDT with rifampicin, clofazimine and dapsone to which he responded within one month... Histoid leprosy usually presents as relapse of lepromatous leprosy after dapsone monotherapy (due to dapsone resistance), or at times de novo... The lesions are usually located on the posterior and lateral aspects of the arms, dorsum of hands, buttocks, thighs, legs, abdomen, and the back... It is more common on bony prominences, especially over the elbows and knees... Histopathological findings of histoid leprosy include epidermal atrophy as a result of dermal expansion of the underlying leproma and acellular band (grenz zone) located below the epidermis... Dermis is filled with fusiform histocytes arranged in a whorled or criss-cross pattern... These histocytes resemble fibroblasts.

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Photomicrograph showing atrophic epidermis, with dermis containing cellular infiltrate of round to polyhedral foamy histocytes with vacuolated cytoplasm and a fair number of plump spindle cells resembling fibroblasts, arranged in a whorled pattern (H and E, ×100)
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Figure 4: Photomicrograph showing atrophic epidermis, with dermis containing cellular infiltrate of round to polyhedral foamy histocytes with vacuolated cytoplasm and a fair number of plump spindle cells resembling fibroblasts, arranged in a whorled pattern (H and E, ×100)

Mentions: A 50-year-old man presented with multiple firm, smooth, painless, non-itchy nodules over his abdomen, back, lower and upper limbs since one year. One week before, he had two episodes of epistaxis. On examination, multiple skin-colored, dome-shaped, non-tender nodules varying in size from 0.5 to 2 cm were found over the abdomen, back and both the upper and the lower limbs, more over the thighs [Figure 1] and knees [Figure 2]. There was partial claw hand [Figure 3] affecting four fingers of the right hand. Right ulnar nerve was thickened. There was no gynecomastia, depressed nasal bridge, loss of eyebrows or any ocular problem. There was no loss of sensation. There was no history of dapsone therapy or multidrug therapy (MDT) in the past. Hematologic findings including liver and renal function tests were normal, except a mildly elevated serum alkaline phosphatase level. Human immunodeficiency virus test was negative. Slit-skin smears examination from skin lesions yielded acid-fast bacilli (AFB) with a bacteriological index of 4+. Excisional biopsy from a firm nodule on abdomen showed a focally atrophied epidermis, beneath which the dermis was seen to contain a large circumscribed cellular infiltrate consisting of round-polyhedral foamy histocytes with vacuolated cytoplasm, and a fair number of plump spindle cells resembling fibroblasts, arranged randomly or in a whorl pattern [Figures 4 and 5]. An unusual histopathological feature was the absence of the grenz zone. Ziehl–Neelsen stain of the section showed abundant, mostly solid AFB within the foamy histocytes, with some lying extracellularly. The bacteriological index of lepra bacilli in the skin lesion was 4+. A final diagnosis of de novo histoid leprosy was made. The patient was placed on MB MDT with rifampicin, clofazimine and dapsone to which he responded within one month.


De novo histoid leprosy.

Kantaria SM - Indian Dermatol Online J (2014)

Photomicrograph showing atrophic epidermis, with dermis containing cellular infiltrate of round to polyhedral foamy histocytes with vacuolated cytoplasm and a fair number of plump spindle cells resembling fibroblasts, arranged in a whorled pattern (H and E, ×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228681&req=5

Figure 4: Photomicrograph showing atrophic epidermis, with dermis containing cellular infiltrate of round to polyhedral foamy histocytes with vacuolated cytoplasm and a fair number of plump spindle cells resembling fibroblasts, arranged in a whorled pattern (H and E, ×100)
Mentions: A 50-year-old man presented with multiple firm, smooth, painless, non-itchy nodules over his abdomen, back, lower and upper limbs since one year. One week before, he had two episodes of epistaxis. On examination, multiple skin-colored, dome-shaped, non-tender nodules varying in size from 0.5 to 2 cm were found over the abdomen, back and both the upper and the lower limbs, more over the thighs [Figure 1] and knees [Figure 2]. There was partial claw hand [Figure 3] affecting four fingers of the right hand. Right ulnar nerve was thickened. There was no gynecomastia, depressed nasal bridge, loss of eyebrows or any ocular problem. There was no loss of sensation. There was no history of dapsone therapy or multidrug therapy (MDT) in the past. Hematologic findings including liver and renal function tests were normal, except a mildly elevated serum alkaline phosphatase level. Human immunodeficiency virus test was negative. Slit-skin smears examination from skin lesions yielded acid-fast bacilli (AFB) with a bacteriological index of 4+. Excisional biopsy from a firm nodule on abdomen showed a focally atrophied epidermis, beneath which the dermis was seen to contain a large circumscribed cellular infiltrate consisting of round-polyhedral foamy histocytes with vacuolated cytoplasm, and a fair number of plump spindle cells resembling fibroblasts, arranged randomly or in a whorl pattern [Figures 4 and 5]. An unusual histopathological feature was the absence of the grenz zone. Ziehl–Neelsen stain of the section showed abundant, mostly solid AFB within the foamy histocytes, with some lying extracellularly. The bacteriological index of lepra bacilli in the skin lesion was 4+. A final diagnosis of de novo histoid leprosy was made. The patient was placed on MB MDT with rifampicin, clofazimine and dapsone to which he responded within one month.

View Article: PubMed Central - PubMed

Affiliation: Consultant Dermatologist, Kantaria Skin Clinic, Porbandar, Gujarat, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Histoid leprosy is a rare form of multibacillary (MB) leprosy with unique clinical and histopathological features... One week before, he had two episodes of epistaxis... On examination, multiple skin-colored, dome-shaped, non-tender nodules varying in size from 0.5 to 2 cm were found over the abdomen, back and both the upper and the lower limbs, more over the thighs [Figure 1] and knees [Figure 2]... There was partial claw hand [Figure 3] affecting four fingers of the right hand... Right ulnar nerve was thickened... Excisional biopsy from a firm nodule on abdomen showed a focally atrophied epidermis, beneath which the dermis was seen to contain a large circumscribed cellular infiltrate consisting of round-polyhedral foamy histocytes with vacuolated cytoplasm, and a fair number of plump spindle cells resembling fibroblasts, arranged randomly or in a whorl pattern [Figures 4 and 5]... The patient was placed on MB MDT with rifampicin, clofazimine and dapsone to which he responded within one month... Histoid leprosy usually presents as relapse of lepromatous leprosy after dapsone monotherapy (due to dapsone resistance), or at times de novo... The lesions are usually located on the posterior and lateral aspects of the arms, dorsum of hands, buttocks, thighs, legs, abdomen, and the back... It is more common on bony prominences, especially over the elbows and knees... Histopathological findings of histoid leprosy include epidermal atrophy as a result of dermal expansion of the underlying leproma and acellular band (grenz zone) located below the epidermis... Dermis is filled with fusiform histocytes arranged in a whorled or criss-cross pattern... These histocytes resemble fibroblasts.

No MeSH data available.


Related in: MedlinePlus