An unusual presentation of leprosy: Lepromatous lymphadenitis

Abstract

An unusual presentation of leprosy: Lepromatous lymphadenitisLeprosy is a nonfatal, chronic inflammatory disease caused by Mycobacterium leprae, whose clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes, and testes.However, here we are reporting a case of leprosy in a 45-year-old male, who presented with bilateral inguinal lymphadenopathy.Left inguinal lymph node was excised surgically and was transported in 10% formalin. Sections were stained with Hematoxylin and Eosin and with modified Ziehl-Neelsen (ZN) technique and were examined under light microscope.Microscopic examination revealed aggregates of foamy histiocytes surrounded by plasma cell infiltrate. Modified ZN stain was performed which showed foamy histiocytes packed with acid-fast lepra bacilli.This report highlights the importance of systemic involvement in leprosy, especially the unusual presentation with lymphadenopathy. Hence, clinicians practicing in endemic areas should bear this fact in mind. Key words: Leprosy, lymphadenopathy, mycobacterium leprae INTRODUCTIONLeprosy is a nonfatal, chronic inflammatory disease caused by Mycobacterium leprae and presents as a spectrum of clinical manifestations from polar tuberculoid to borderline tuberculoid to mid-borderline to borderline lepromatous to polar lepromatous disease, which is associated with an evolution from asymmetric localized macules and plaques to nodular and indurated symmetric generalized skin manifestations, an increasing bacterial load, and loss of leprae-specific cellular immunity. However, in any part of the spectrum the clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes, and testes. [1] The prevalence of leprosy in India is reported to be 0.7/10,000 populations. [2] The disease should be suspected when a patient from an endemic area has suggestive skin lesions or peripheral neuropathy. However, this disease can even present with lymphadenopathy only, as can be seen in this particular case. CASE REPORTA 45-year-old male patient was referred to our institute with the complaints of gradually increasing swelling in the inguinal areas of both sides for 6 months duration. The swellings were painless. On clinical examination, the patient was found to have enlargement of inguinal lymph nodes on both sides, the left-sided swelling was 2.0 cm and the right sided one was 1.5 cm in greatest dimension. Excision of the left inguinal lymph node was done surgically and sent to our department for histopathological examination. Fine needle aspiration cytology (FNAC) was not done as it would destroy the lymph nodal architecture.Left inguinal lymph node was excised surgically and was transported in 10% formalin. Grossly, the tissue was globular capsulated mass measuring 2.0 cm × 1.8 cm × 1.5 cm. Cut section was homogenous and grayish white in color. Formalin fixed and paraffin embedded sections were made. Sections were stained with Hematoxylin and Eosin stain and also with modifi...