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De novo histoid leprosy: a case report from a post-elimination area.

Bhat YJ, Hassan I, Yaseen A, Wani R - Indian J Dermatol (2015 Mar-Apr)

Bottom Line: Histoid leprosy is an uncommon variant of lepromatous leprosy that usually follows treatment failure.Occasionally it occurs de novo without any history of previous inadequate or irregular treatment.We, hereby, report a case of de novo histoid leprosy in a 25-year-old man from the post-elimination area of Kashmir, where the prevalence rate of the disease was reported to be 0.17/10000 in March, 2013 (NLEP).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, STD and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India.

ABSTRACT
Histoid leprosy is an uncommon variant of lepromatous leprosy that usually follows treatment failure. Occasionally it occurs de novo without any history of previous inadequate or irregular treatment. We, hereby, report a case of de novo histoid leprosy in a 25-year-old man from the post-elimination area of Kashmir, where the prevalence rate of the disease was reported to be 0.17/10000 in March, 2013 (NLEP).

No MeSH data available.


Related in: MedlinePlus

Cells filled with numerous acid fast M. leprae (Fite Faraco stain × 400)
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Figure 4: Cells filled with numerous acid fast M. leprae (Fite Faraco stain × 400)

Mentions: A 25-year-old unmarried native Kashmiri man, presented with a 3 months history of raised skin colored lesions over the trunk and limbs with decreased sensations of the right foot. The lesions first appeared over the upper limbs and then progressed to involve the back, chest, abdomen, lower limbs and face in that order. The lesions were asymptomatic. There was history of burning sensation in the eyes, nasal stuffiness and swelling of feet. The patient denied any drug intake, fever, arthralgias, myalgias, spontaneous blistering or ulceration and testicular pain. None of the family members had suffered from leprosy. His general physical examination was normal with no madarosis or lymphadenopathy. Cutaneous examination revealed multiple shiny, soft, hemispherical, non-tender, skin colored to erythematous papules and nodules present bilaterally on the forehead, cheeks, forearms, back, chest, the abdomen in the periumblical distribution, thighs and legs with sparing of palms and soles [Figure 1]. Neurological examination revealed thickened (Grade 2) bilateral greater auricular (left being tender also) [Figure 2], bilateral ulnar and right radial cutaneous nerves. Pain, touch and temperature sensations were markedly diminished along the lateral border of right foot. Rest of the musculo-skeletal and neurological examination was normal. Routine hematological and biochemical investigations including urine, renal and liver function test revealed no abnormality. His retroviral serology was negative. Slit skin smear showed a full field of AFB and globi, with a BI>5+ and MI of 75%. A lesional biopsy revealed focal collections of foamy histiocytes seen beneath the atrophic epidermis [Figure 3]. Fite faraco staining showed cells filled with numerous AFB [Figure 4] which are arranged singly, are longer than the normal bacilli, uniform in length, and are arranged in parallel bundles along the long axis of histiocytes. Findings were consistent with HL (cells contained acid fast organisms on H and E stain). So a diagnosis of de novo HL was made. The patient was given a single dose of ROM therapy as rifampicin rapidly reduces the bacillary load and ofloxacin and minocycline have strong bactericidal action. He was also instructed to take MBMDT for 1 year. The patient is on regular follow up and is free of lesions.


De novo histoid leprosy: a case report from a post-elimination area.

Bhat YJ, Hassan I, Yaseen A, Wani R - Indian J Dermatol (2015 Mar-Apr)

Cells filled with numerous acid fast M. leprae (Fite Faraco stain × 400)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372946&req=5

Figure 4: Cells filled with numerous acid fast M. leprae (Fite Faraco stain × 400)
Mentions: A 25-year-old unmarried native Kashmiri man, presented with a 3 months history of raised skin colored lesions over the trunk and limbs with decreased sensations of the right foot. The lesions first appeared over the upper limbs and then progressed to involve the back, chest, abdomen, lower limbs and face in that order. The lesions were asymptomatic. There was history of burning sensation in the eyes, nasal stuffiness and swelling of feet. The patient denied any drug intake, fever, arthralgias, myalgias, spontaneous blistering or ulceration and testicular pain. None of the family members had suffered from leprosy. His general physical examination was normal with no madarosis or lymphadenopathy. Cutaneous examination revealed multiple shiny, soft, hemispherical, non-tender, skin colored to erythematous papules and nodules present bilaterally on the forehead, cheeks, forearms, back, chest, the abdomen in the periumblical distribution, thighs and legs with sparing of palms and soles [Figure 1]. Neurological examination revealed thickened (Grade 2) bilateral greater auricular (left being tender also) [Figure 2], bilateral ulnar and right radial cutaneous nerves. Pain, touch and temperature sensations were markedly diminished along the lateral border of right foot. Rest of the musculo-skeletal and neurological examination was normal. Routine hematological and biochemical investigations including urine, renal and liver function test revealed no abnormality. His retroviral serology was negative. Slit skin smear showed a full field of AFB and globi, with a BI>5+ and MI of 75%. A lesional biopsy revealed focal collections of foamy histiocytes seen beneath the atrophic epidermis [Figure 3]. Fite faraco staining showed cells filled with numerous AFB [Figure 4] which are arranged singly, are longer than the normal bacilli, uniform in length, and are arranged in parallel bundles along the long axis of histiocytes. Findings were consistent with HL (cells contained acid fast organisms on H and E stain). So a diagnosis of de novo HL was made. The patient was given a single dose of ROM therapy as rifampicin rapidly reduces the bacillary load and ofloxacin and minocycline have strong bactericidal action. He was also instructed to take MBMDT for 1 year. The patient is on regular follow up and is free of lesions.

Bottom Line: Histoid leprosy is an uncommon variant of lepromatous leprosy that usually follows treatment failure.Occasionally it occurs de novo without any history of previous inadequate or irregular treatment.We, hereby, report a case of de novo histoid leprosy in a 25-year-old man from the post-elimination area of Kashmir, where the prevalence rate of the disease was reported to be 0.17/10000 in March, 2013 (NLEP).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, STD and Leprosy, Government Medical College, Srinagar, Jammu and Kashmir, India.

ABSTRACT
Histoid leprosy is an uncommon variant of lepromatous leprosy that usually follows treatment failure. Occasionally it occurs de novo without any history of previous inadequate or irregular treatment. We, hereby, report a case of de novo histoid leprosy in a 25-year-old man from the post-elimination area of Kashmir, where the prevalence rate of the disease was reported to be 0.17/10000 in March, 2013 (NLEP).

No MeSH data available.


Related in: MedlinePlus