Hyperpigmented Macule on the Palm and Diminished Sensation

Abstract

A previously healthy, 25-year-old woman presented with a hyperpigmented macule on the medial side of her right palm. She reported hypoesthesia over the lesion. Two years ago, she immigrated to the United States from Bangladesh. Five months ago, she visited Bangladesh to get married. A biopsy of the lesion obtained there showed multiple perineural granulomas with inflammatory cells. Gram stain and acid-fast bacillary and fungal stains of the biopsy specimen were negative. The patient was prescribed 1 dose each of doxycycline, ofloxacin, and rifampin and experienced no improvement.On physical examination there was a mildly erythematous macule located over the medial aspect of the right palm, with loss of touch and temperature sensation over the involved area (Figure). A thickened, nontender ulnar nerve was palpated on the ipsilateral side in the olecranon fossa. Diagnosis Tuberculoid leprosy with a single lesion and ulnar nerve involvementClinical Review & Education JAMA Clinical Challenge

Palmoplantar Involvement in Leprosy: A Clinicopathological Study

“…Recently, a single case with isolated palmar involvement in leprosy has been reported from the United States. 14 The major limitation of this study was its retrospective nature, which might have led to underreporting of palmoplantar lesions as they can often be clinically silent.…”