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Anais Brasileiros de Dermatologia

versão impressa ISSN 0365-0596versão On-line ISSN 1806-4841

An. Bras. Dermatol. vol.90 no.5 Rio de Janeiro set./out. 2015

http://dx.doi.org/10.1590/abd1806-4841.20154049 

Images in Tropical Dermatology

Histoid leprosy: a rare exuberant case*

Pedro Jose Secchin de Andrade1 

Sulamita dos Santos Nascimento Dutra Messias2 

Paola Cristina Brandão Oliveira Ferreira2 

Anna Maria Sales1 

Alice de Miranda Machado1 

José Augusto da Costa Nery1 

1Oswaldo Cruz Foundation (Fiocruz) – Rio de Janeiro (RJ), Brazil.

2Estácio de Sá University – Rio de Janeiro (RJ), Brazil.

Abstract

Leprosy is a neglected disease. We point up the need of recognizing the unusual clinical presentations of the disease in order to make early diagnosis and proper treatment possible, and break the transmission chain. The authors report a rare type of multibacillary leprosy: histoid leprosy and present images of numerous well-circumscribed indurated papules and nodules distributed throughout the entire body.

Keywords: Diagnosis, differential; Leprosy; Leprosy, multibacillary; Mycobacterium leprae; Neglected diseases

Histoid leprosy, an uncommon form of multibacillary leprosy, was first described by Wade in 1963.1Clinically, it is characterized by the presence of numerous indurated, infiltrated, keloid, skin-colored or erythematous papules and nodules with no preferred location (Figures 1,2and3).2,3,4Skin histology reveals an abundant amount of bacilli and elongated or fusiform histiocytes, similar to neurofibroma.3,5,6This form is rare in treatment-naïve patients. The literature discusses causal factors, such as drug resistance to dapsone or mutation of strains of Mycobacterium leprae..2,7The differential diagnosis should be made with sarcoidosis, dermatofibroma, cutaneous metastasis and angiosarcoma.8

Figure 1 Presence of keloid papules and nodules on the face 

Figure 2 Papular-nodular erythematous lesions and some crusts on the back and upper limb 

Figure 3 Presence of several papular-nodular, ulcerated, crusted lesions on the left forearm and left hand 

We report the case of a 23-year-old male patient who lived in an endemic area of Rio de Janeiro and had an "18-month history of numerous nodules throughout the body." He denied leprosy. Serologies for HIV, syphilis and hepatitis B and C were negative. Skin smear showed a bacteriological index of 5.75. Mitsuda test was negative. No changes in sensitivity were seen. The patient had no disability degree. Wade staining showed multiple acid-alcohol fast bacilli with bacteriological index of 6+, histopathologically classified as histoid leprosy. The patient started multidrug therapy for multibacillary leprosy (Figures 4).

Figure 4 Microphotograph of the biopsy of the lesion showing hypercellular areas with rounded and fusiform macrophages arranged in stripes; large vacuoles are observed in between; HE, 200x. Insert: Intact bacilli, bacteriological index of 6+ (LIB = 5.95); Wade's method, 1000x 

Furthermore, it is important that health professionals recognize atypical leprosy presentations in order to perform appropriate treatment. Late diagnosis of a bacilliferous patient may occur and favors the transmission chain.9

Financial Support: None.

How to cite this article: Andrade PJS, Messias SSND, Ferreira PCBO, Sales AM, Machado AM, Nery JAC. Histoid leprosy: a rare exuberant case . An Bras Dermatol. 2015;90(5):756-7.

*Study conducted at the Souza Araújo Outpatient clinic (ASA), Leprosy Laboratory (LAHAN), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz) – Rio de Janeiro (RJ), Brazil.

REFERENCES

Wade HW. Histoid variety of lepromatous leprosy. Int J Lepr. 1963;31:129-42. [ Links ]

Rodriguez JN. The histoid leproma, its characteristics and significance. Int J Lepr Other Mycobact Dis. 1969;37:1-21. [ Links ]

Sehgal VN, Srivastava G. Status of histoid leprosy - a clinical, bacteriological, histopathological and immunological appraisal. J Dermatol. 1987;14:38-42. [ Links ]

Kaur I, Dogra S, De D, Saikia UN. Histoid leprosy: a retrospective study of 40 cases from India. Br J Dermatol. 2009;160:305-10. [ Links ]

Nair SP, Moorthy KP, Suprakasan S, Jayapalan S, Mini G. Histoid leprosy - unusual presentation. Int J Dermatol. 2006;45:433-4. [ Links ]

Sehgal, VN, Govind S, Navjeevan S. Histoid leprosy: histopathological connotations' relevance in contemporary context. Am J Dermatopathol. 2009;31:268-71. [ Links ]

Mansfield RE. Histoid leprosy. Arch Pathol. 1969;87:580-5. [ Links ]

Sehgal VN, Srivastava G, Singh N, Prasad PV. Histoid leprosy: the impact of the entity on the postglobal leprosy elimination era. Int J Dermatol. 2009;48:603-10. [ Links ]

Lastória JC, Carlos AM, Putinatti MSMA. Hanseníase: realidade no seu diagnóstico clínico. Hansen Int. 2003;28:53-8. [ Links ]

Recebido: 17 de Setembro de 2014; Aceito: 12 de Janeiro de 2015

MAILING ADDRESS: Pedro Jose Secchin de Andrade, Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil 4365 - Manguinhos, 21040-360 - Rio de Janeiro - RJ - Brazil. E-mail:p_secchin@hotmail.com

Conflict of Interest: None.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.