No abstract

A 35-year-old woman visited our venereal disease outpatient clinic to be tested for HIV infection. Sbe bad been working as a prostitute on tbe Soutb American mainland, tbe Caribbean, and in New York City. Sbe bad never used intravenous drugs. Her medical bistory revealed tbat sbe had a hepatitis B infection in 1978 and primary syphilis in 1984 for wbich she had been treated. Besides general symptoms of weight loss and anorexia, she had recently developed an anesthetic skin lesion on her right upper arm.Upon dermatologic examination, a hypopigmented macule of 6-7 cm in diameter with a minimal elevated slightly erythematous border was observed on her right upper arm. The sensitivity to light touch in tbe center of this lesion was clearly diminished as compared to tbat of the surrounding skin. A small hypopigmented macule with normal sensation was also seen on tbe abdomen. Peripheral nerves were not enlarged and there were no signs of peripheral neuropathy.Clinically, the lesions were compatible witb borderline tuberculoid-mid borderline (BT/BB) leprosy. Histologic examination of the biopsy specimens taken from the lesion on the upper arm showed perivascular and perineural lymphohistiocytic infiltrations with a tendency to granuloma formation. In and around the granuloma a mild extracellular edema was seen. Some of the histiocytes bad foamy cytoplasm and in a Wade-Fite's stained preparation contained solid staining acid-fast bacteria. The same histologic features, but with markedly less lymphocytic infiltrate, were observed in tbe specimen from the lesion of the abdomen. Tbe bistopathology was that of a borderline lepromatous (BL) leprosy in reaction. Immunobistochemical studies of the biopsy specimens showed that HLA-Dr was not expressed on the keratinocytes in the epidermis. There was a decrease in the number of Langerhans cells in tbe epidermis. The granulomas consisted of 75% T lymphocytes (CD3-I-cells) and 25% histiocytes. The lympbocytic infiltrate consisted of 50% CD4-f and 30 to 40% CD8-I-cells. No interleukin-2 (IL-2) receptor positive cells or natural killer (NK) cells were present in the infiltrate.