Histoid leprosy: the impact of the entity on the postglobal leprosy elimination era

Sehgal, Virendra; Srivastava, Govind; Singh, Navjeevan; Prasad, P. V. S.

doi:10.1111/j.1365-4632.2009.03992.x

Cited by 27 publications

(42 citation statements)

References 29 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%

“…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%

“…The fact that histoid leprosy has been reported following adequate multidrug treatment is especially noteworthy (24,25). It is commonly believed that histoid leprosy bacilli are resistant to DDS, and although this has been confirmed several times, there are other cases in which it has not happen or it has not been demonstrated (9).…”

Section: Discussionmentioning

confidence: 99%

“…The patient's characteristics sustaining a diagnosis of histoid leprosy included her good general condition, in spite of the profuse and chronic nodular and tumor-like lesions, well-delimited lesions with sharp borders on apparently normal skin and bony prominences, and the two skin biopsies showing diffuse macrophage inflammation with fusiform cells, admixed with some slightly vacuolated macrophages, both of them containing abundant acid-fast elongated intact bacilli with no granular forms and no tendency to form globii (1-9). Epistaxis is frequently described in histoid leprosy (6)(7)(8)(9)(10)(11). Furthermore, positive bacilloscopies of nasal, ear and elbow smears are also seen in this type of leprosy (6,8,9,12).…”

Section: Discussionmentioning

confidence: 99%

“…Epistaxis is frequently described in histoid leprosy (6)(7)(8)(9)(10)(11). Furthermore, positive bacilloscopies of nasal, ear and elbow smears are also seen in this type of leprosy (6,8,9,12). A unique finding in this case was the presence of nodules and tumors on fingers and toes.…”

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%