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Pradeep S-Aclinical and Histopathological Study of Histoid Leprosy
Pradeep S-Aclinical and Histopathological Study of Histoid Leprosy
Pradeep S-Aclinical and Histopathological Study of Histoid Leprosy
1
Departments of Dermatology and Abstract
Venereology, and 2Pathology, Government Background Histoid leprosy (HL) is a rare variant of lepromatous leprosy presenting with
Medical College, Trivandrum, Kerala, India
well-defined smooth shiny papules and nodules. This can mimic many other dermatoses
Correspondence
and can be missed clinically.
Dr Sukumaran Pradeep Nair, MD Methods This is a retrospective 10-year study. Data were obtained and analyzed from
Department of Dermatology and case records of the urban leprosy clinic at the Government Medical College, Trivandrum,
Venereology Kerala (India).
Government Medical College Trivandrum
Results There were 17 cases of HL in this study. The male/female ratio was 16 : 1 and
695011
the 4150-year-old age group accounted for the maximum number of cases (six, 35.29%);
Kerala
India 11 cases (64.70%) were de novo cases of HL. Papules were the commonest skin lesions
E-mail: dvmchtvm@yahoo.co.in encountered (17, 100%), while the upper and lower limbs and trunk were the most
common sites involved (11, 64.70%). Earlobe infiltration was seen in 10 cases (58.82%).
Conflicts of interest: None.
Lepra reactions were seen in four (23.52%) cases. Deformity/disability occurred only in two
cases (11.76%). The mean morphological index was 30.58%, while the mean
bacteriological index was 5.17. Epidermal atrophy and a well-circumscribed dermal area
packed with spindle-shaped histiocytes and positive for acid-fast bacilli were the main
histopathological features seen.
Conclusions The majority of cases in this study were de novo. HL can occur even when
there is no history of inadequate or irregular treatment. Papules rather than nodules were
the most common skin lesions seen. Earlobe infiltration was seen in the majority of cases
unlike that reported in the literature. Lepra reactions are very rare in HL.
International Journal of Dermatology 2013, 52, 580586 2013 The International Society of Dermatology
Pradeep Nair and Nanda Kumar Clinico-pathological study of histoid leprosy Tropical medicine rounds 581
2013 The International Society of Dermatology International Journal of Dermatology 2013, 52, 580586
582 Tropical medicine rounds Clinico-pathological study of histoid leprosy Pradeep Nair and Nanda Kumar
ENL, erythema nodosum leprosum; F, face; H, de novo histoid leprosy; I-H, indeterminate leprosy relapsed as histoid; L, lower
limb; LL-H, lepromatous leprosy relapsed as histoid; M, macule; N, nodule; P, papule; PL, plaque; T, trunk; Tu, tumor-like
masses; U, upper limb.
entity. The total number of cases in this study was 17, is the large number of de novo cases of HL (64.70%)
indicating the rarity of HL. A previous similar study by compared with another major study by Kaur et al.,9
Kaur et al.,9 had 40 cases. The incidence of HL in our where de novo cases of HL accounted for only 12.5%.
study was 2.05%. The study by Kaur et al. had an inci- The very large number of de novo cases could be due to
dence of 1.8%, Mendiratta et al., 1.14%, and by Kalla them being referred to this tertiary care institute for want
et al., 2.8%, all indicating again the rarity of HL.911 of a definite diagnosis owing to the atypical presentations
The male: female ratio of 16 : 1 in this study is much of HL. The high index of suspicion maintained in this
higher than the studies done by Kaur et al. (5.7 : 1) and center enabled us to pick out cases that were missed else-
Sehgal and Srivastava (8.2 : 1).9,12 The 4150-year-old where. The large number of de novo cases portrays a
age group accounting for the maximum number of cases grave situation as these patients are highly bacilliferous
in this study is similar to the study by Kaur et al., and in and are infectious with drug-resistant strains. The
contrast to studies by Sehgal and Srivastava, and Kalla de novo cases could be due to single or multiple drug-
et al., where the 2040-year-old age group was most resistant strains; however, microbiological confirmation
commonly affected.9,11,12 A unique highlight of this study with mouse foot pad inoculation was not possible in this
International Journal of Dermatology 2013, 52, 580586 2013 The International Society of Dermatology
Pradeep Nair and Nanda Kumar Clinico-pathological study of histoid leprosy Tropical medicine rounds 583
Well Appendages
circumscribed Spindle- in the
Case BI MI Epidermal Grenz Pseudo- area of cells shaped circumscribed
no. (+) (%) atrophy zone capsule in the dermis histiocytes area of cells
1 5.33 60 + + + + +
2 6 30 + + + + +
3 5 40 + + + +
4 4.66 40 + + + +
5 3 10 + + + +
6 3 20 + + +
7 6 50 + + + + +
8 6 30 + + +
9 5.33 10 + + + +
10 6 15 + + + +
11 5.33 40 + + + + +
12 5 10 + + + +
13 6 40 + + +
14 6 50 + + + + +
15 5.33 20 + + + +
16 5 25 + + + +
17 5 30 + + + +
2013 The International Society of Dermatology International Journal of Dermatology 2013, 52, 580586
584 Tropical medicine rounds Clinico-pathological study of histoid leprosy Pradeep Nair and Nanda Kumar
International Journal of Dermatology 2013, 52, 580586 2013 The International Society of Dermatology
Pradeep Nair and Nanda Kumar Clinico-pathological study of histoid leprosy Tropical medicine rounds 585
References
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2013 The International Society of Dermatology International Journal of Dermatology 2013, 52, 580586
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International Journal of Dermatology 2013, 52, 580586 2013 The International Society of Dermatology