No abstract

Summary Leprosy is primarily a disease of the peripheral nerves and a technique that is simpler than nerve biopsy is required to evaluate nerve involvement, especially in pure neuritic (PN) leprosy. This study was designed to evaluate the role of FNAC of the nerve in the diagnosis and classification of leprosy. A prospective study was carried out on 25 patients with clinically active leprosy and at least one thickened peripheral sensory nerve. Nerve aspirates were evaluated by May-Grunwald Giemsa and Fite's staining. Lepromin test, slit skin smears (SSS), skin biopsies (except PN cases) and nerve biopsies were performed and compared with FNAC.FNAC of nerve from 23 cases (92%) yielded diagnostic aspirates. Acid fast bacilli were observed in six cases by FNAC. FNAC and nerve pathology were equally comparable with the other parameters evaluated. Based on the results, cytological criteria were developed for interpreting nerve aspirates and the cases were classified as paucibacillary (18), BB (2), BL (2), LL (1) and non-diagnostic (2). All PN cases showed diagnostic paucibacillary type cytology. FNAC of the nerve yields diagnostic aspirates in leprosy comparable with nerve pathology and the proposed cytological criteria may be useful in classification of nerve aspirates.Although leprosy is primarily a disease of the peripheral nerves, the main criteria for diagnosis and classification are related to skin parameters such as slit skin smears (SSS) and skin biopsies. 1 -3 Several studies have shown discrepancies between skin and nerve histopathology, with a higher bacterial load in the peripheral nerves when compared to the skin. 4 -S In addition, pure neuritic (PN) leprosy, which involves the nerves alone with out any skin changes, is a definite entity recognized in the Indian classification of leprosy. 9 The diagnosis of this form of leprosy can be confirmed only by a nerve biopsy?

Amyloidosis cutis dyschromica (ACD), a rare distinct type of primary cutaneous amyloidosis was noted in two siblings: a 25-year-old male and his brother aged 20 years. It was characterized by reticulate hyperpigmentation with hypopigmented spots seen almost all over the body without any papulation. This familial disorder has been reported mostly from Japan. Our report of familial ACD is probably the first from India.

We describe a 37-year-old woman who presented with palmoplantar pigmentation, thickening and pitting of 4 years duration. Bluish pigmented patches were seen over the sclera of her eyes. Her lumbar spine showed typical calcification of the intervertebral discs. Addition of Benedict's reagent to a urine sample of the patient gave rise to greenish brown precipitate and brownish black supernatant. Alkalinization of urine turned it black. A biopsy of the palmar lesion demonstrated irregular breaking up, swelling and homogenization of collagen bundles in the reticular dermis. Yellow-brown (ochre coloured) pigment was seen lying within the collagen bundles and also freely in the deeper dermis confirming our clinical diagnosis of alkaptonuric ochronosis. To the best of our knowledge this is probably the second report of alkaptonuria presenting with palmoplantar pigmentation.

Although human anthrax has become rare, endemic outbreaks still occur in tropical countries, parts of South America and Europe. We report 23 cases of cutaneous anthrax due to an endemic outbreak of animal and human anthrax in South India. These patients were admitted to our hospital between July 1998 and July 2001. Children outnumbered adults and most of them had lesions on the exposed sites. The majority of patients reported the death of infected animals in the neighbourhood without any direct contact with dead animals. Hence, vector borne transmission was suspected in most of the cases. Diagnosis was confirmed by the presence of a typical ulcer with eschar, Gram-stained smears from ulcers and epidemiological evidence. Except for one fatal case, all patients responded to treatment.