Histoid leprosy: a retrospective study of 40 cases from India

Kaur, Inderjeet; Dogra, Sunil; De, Dipankar; Saikia, Uma Nahar

doi:10.1111/j.1365-2133.2008.08899.x

Cited by 71 publications

(113 citation statements)

References 9 publications

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“…They may show superficial ulceration and some papules are centrally depressed or umbilicated, mimicking molluscum contagiosum (17). Lesions prevail on thighs, buttocks, arms, back, face, forearms and legs (1,6,8,9). Lesions on fingers and toes, as those found in our patient, have not been described before.…”

Section: Discussionsupporting

confidence: 68%

“…Madarosis, which is occasionally present (12,20), was a clue finding to deduce the right diagnosis in our case. Peripheral nerve enlargement, also a common finding (1,8,18), was slightly apparent in our case. Nodular swelling of cutaneous nerves is another presentation of histoid leprosy, sometimes as a relapse of lepromatous leprosy (21).…”

Section: Discussionsupporting

confidence: 61%

“…To make a proper histopathologic diagnosis of histoid leprosy, a mandatory study of this disease (9,14), it is necessary to study a complete papule, nodule or tumor, which would show its circumscription and its expansive and not infiltrative character, as well as epidermal compression and atrophy (1,3,4,6,8,9,14). The periphery of the lesion may contain numerous lymphocytes and also pale vacuolated histiocytes, as was seen in this biopsy.…”

Section: Discussionmentioning

confidence: 93%

“…Occasionally, leprosy is very difficult to diagnose, particularly in cases of histoid leprosy, which may be overlooked even by experts (1). When the clinical photographs of this patient were shown to a dermatologist, expert in leprosy, he claimed that: "These lesions cannot be of leprosy".…”

Section: Discussionmentioning

confidence: 96%

“…It was considered as the result of dapsone-resistant bacilli (16), and it appears with cutaneous and subcutaneous papules, nodules and tubercles (from one to more than 100), and with plaques mainly over bone surfaces of elbows and knees (1)(2)(3)(6)(7)(8). Nodules and tumorlike lesions appear very well defined, erythematous, firm, hypo or anesthetic over apparently normal skin and they measure from 0.5 to 5 cm in diameter (6-9,13).…”

Section: Discussionmentioning

confidence: 99%

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Lepra histioide con lesiones gigantes de los dedos y los artejos

et al. 2014

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This work was conducted at the Facultad de Medicina, Universidad de La Sabana, and at the Facultad de Medicina, Universidad Surcolombiana.Histoid leprosy, a clinical and histological variant of multibacillary leprosy, may offer a challenging diagnosis even for experts. An 83-year-old woman presented with papular, nodular and tumor-like lesions of 3 years of evolution, affecting fingers, toes, hands, thighs and knees, and wide superficial ulcers in her lower calves. Cutaneous lymphoma was suspected. A biopsy of a nodule of the knee showed a diffuse dermal infiltrate with microvacuolated histiocytes, moderate numbers of lymphocytes and plasma cells. Cutaneous lymphoma was suggested. Immunohistochemistry (IHC) showed prominent CD68-positive macrophages, as well as CD3, CD8 and CD20 positive cells. Additional sections suggested cutaneous leishmaniasis. New biopsies were sent with the clinical diagnoses of cutaneous lymphoma, Kaposi´s sarcoma or lepromatous leprosy, as the patient had madarosis. These biopsies showed atrophic epidermis, a thin Grenz zone and diffuse inflammation with fusiform cells and pale vacuolated macrophages. ZiehlNeelsen stain showed abundant solid phagocytized bacilli with no globii formation. Abundant bacilli were demonstrated in the first biopsy. Histoid leprosy was diagnosed. The patient received the WHO multidrug therapy with excellent results. We concluded that Ziehl Neelsen staining should be used in the presence of a diffuse dermal infiltrate with fusiform and vacuolated histiocytes, which suggests a tumor, and an IHC particularly rich in CD68-positive macrophages; this will reveal abundant bacilli if the lesion is leprosy. A good clinical pathological correlation is essential to establish a proper diagnosis and management of the patient.Key words: Leprosy; leprosy, multibacillary; leprosy, lepromatous. doi: http://dx.doi.org/10.7705/biomedica.v35i2.2562 Lepra histioide con lesiones gigantes de los dedos de manos y piesLa lepra histioide es una forma de lepra multibacilar de diagnóstico clínico e histológico difícil incluso para expertos. Una mujer de 83 años se presentó a consulta con pápulas, nódulos y tumores de tres años de evolución en los dedos de manos y pies, y en manos, muslos y rodillas, así como úlceras superficiales extensas en la porción inferior de las pantorrillas, ante lo cual se sospechó linfoma cutáneo. La biopsia de un nódulo de la rodilla mostró infiltrado dérmico difuso con histiocitos microvacuolados y algunos linfocitos y plasmocitos. Se sugirió la posibilidad de un linfoma cutáneo. La inmunohistoquímica demostró macrófagos prominentes positivos para CD68 y células CD3, CD8 y CD20. Con base en los cortes adicionales de la biopsia, se sugirió la presencia de leishmaniasis cutánea. Se tomaron nuevas biopsias con las sugerencias diagnósticas de linfoma cutáneo, sarcoma de Kaposi o lepra lepromatosa, pues la paciente presentaba madarosis. Estas mostraron epidermis atrófica, una delgada zona subepidérmica de colágeno denso y dermatitis difusa con células fusiformes y a...

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Section: Discussionsupporting

confidence: 68%