De-novo Histoid Hansen cases

Vora, Rita V; Pilani, Abhishek P; Mehta, Malay J; Chaudhari, Arvind; Patel, Nidhi

doi:10.4103/0974-777x.127944

Cited by 5 publications

(4 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It may also appear de novo, as the initial clinical presentation of leprosy. Papules and nodules appear upon apparently normal skin in cases with no previous history of leprosy treatment (1,8,11,23), as in our patient.…”

Section: Discussionsupporting

confidence: 76%

“…Histoid leprosy represents a challenge for leprosy elimination campaigns because of the usual delay in diagnosis, its difficult clinical and histopathological identification, its great bacillary index, the eventual resistance of the bacilli to DDS and the occurrence of lepromatous leprosy relapses manifesting as histoid leprosy after complete MDT (9,14,23,25).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lepra histioide con lesiones gigantes de los dedos y los artejos

et al. 2014

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Lepra histioide con lesiones gigantes de los dedos y los artejos

et al. 2014

View full text Add to dashboard Cite

show abstract

“…After the introduction of MDT in 1981, HL became even less frequently observed. Most of the cases were reported from India, a high-prevalence country for the disease [3]. De novo HL, not related to previous anti-leprosy therapy, has been described only in few cases.…”

Section: Discussionmentioning

confidence: 99%

Wade histoid leprosy revisited

Sousa

Laureano²,

Cardoso³

2016

Dermatology Online Journal

View full text Add to dashboard Cite

An 18-year-old man presented with a 4-year history of erythematous patches on the trunk, followed 2-years later by multiple nodules, mostly located on the limbs, and distal paresthesias. Two close contacts were treated for leprosy during his childhood. Histopathological examination revealed a histiocytic infiltrate with acid-fast bacilli on Ziehl-Neelsen stain. The slit-skin and nasal smears showed numerous acid-fast bacilli. The correlation between clinical, epidemiological, histopathological, and microbiological features allowed the diagnosis of lepromatous leprosy, histoid variant. Multidrug therapy as recommended by the WHO was initiated. A rapid and sustained improvement was seen. Histoid leprosy is a rare manifestation of lepromatous leprosy, first described by Wade in 1960. Since then few cases have been reported, the majority of them from countries with a high prevalence of the disease. Early recognition and treatment are of most importance to prevent neurological disabilities and achieve epidemiological control.

show abstract

“…(3) Causal factors could be drug resistance to Dapsone, or mutation of strains of Mycobacterium leprae. (4) Treatment with Dapsone alone may create an environment by killing the drug-sensitive micro-organisms, which may allow the growth of resistant bacilli.…”

Section: Introductionmentioning

confidence: 99%