Case Of Lepromatous Leprosy Research Articles

Clinically Suspicious Cases of Hansen's Disease at a Tertiary Care Hospital in South India: A Clinicopathological Study.

Background and objective Hansen's disease, also known as leprosy, is a chronic granulomatous condition caused by Mycobacterium leprae, primarily affecting the skin and peripheral nerves. The disease has a wide spectrum of clinical and histopathological manifestations, often mimicking other inflammatory and infectious conditions. This variability poses significant challenges in its early diagnosis and management. Aligning clinical suspicion with histopathological evidence is critical for effective treatment and control of transmission. This study was designed to explore the concordance between clinical impressions and histopathological diagnoses and to understand the diagnostic utility of various histopathological techniques. We aimed to establish and correlate the histopathological types of leprosy with clinical presentations. We also sought to determine the extent to which different histopathological techniques, including special stains, can corroborate with clinical types, thereby enhancing diagnostic precision. Materials and methods This was a hospital-based, retrospective study of clinically suspicious cases of leprosy at a tertiary care hospital in South India. A total of 100 cases of various age groups were identified and included in the study. All cases underwent skin biopsy with samples subjected to routine hematoxylin and eosin (H&E) staining and acid-fast bacilli (AFB) staining for the detection oflepra bacilli. Results Among the 100 clinically suspicious cases of leprosy, 50were histopathologically confirmed as leprosy and 50were categorized as non-specific dermatitis. Among the 50 histologically confirmed cases of leprosy, the most common type was lepromatous leprosy (LL) (38%) followed by borderline tuberculoid (BT) (30%) leprosy.Modified AFBstain was positive in 21 cases and was instrumental in confirming the suspected cases of leprosy. The overall correlation between the clinical and histopathological diagnosis was significant, with the highest correlation noted in LL cases. Conclusions Our findings underscorethe complexity of diagnosing leprosy due to its varied clinical and pathological presentations. Despite a high overall concordance rate, the discrepancies between clinical impressions and histopathological findings observed highlight the need for a multidimensional diagnostic approach. Incorporating a combination of clinical assessment, routine histology, and special staining can enhance diagnostic accuracy, leading to better patient management and outcomes.

Bridging dermatology and hematology: a case of lepromatous leprosy with bone marrow involvement and pancytopenia.

Leprosy, caused by Mycobacterium leprae (M. leprae), primarily manifestswith cutaneous and peripheral nerve involvement. Systemic involvement, particularly in the bone marrow, is exceedingly rare. This report presents a case of lepromatous leprosy with bone marrow involvement, emphasizing the systemic nature of the disease and the importance of comprehensive diagnostic and management approaches. We aim to present a case of lepromatous leprosy with bone marrow involvement, detailing the clinical presentation, diagnostic evaluation, and management approach. A 65-year-old male with lepromatous leprosy and severe erythema nodosum leprosum developed pancytopenia. After undergoing comprehensive clinical evaluation, including history taking, physical examination, and laboratory investigations, bone marrow examination and molecular diagnostics using polymerase chain reaction (PCR) were performed to confirm the presence of M. leprae as an etiology for his pancytopenia. The bone marrow aspirate revealed hypercellularity with erythropoiesis and thrombopoiesis within normal limits. Foamy histiocytes with erythrophagocytosis were observed, along with the presence of M. leprae on Modified Ziehl-Neelsen stain. Molecular analysis confirmed M. leprae DNA in the bone marrow aspirate. Treatment with multi-drug therapy (MDT) and thalidomide resulted in normalization of blood counts and healing of skin lesions. This case underscores the systemic nature of leprosy and the rarity of bone marrow involvement, highlighting the importance of thorough evaluation in cases of persistent symptoms. Comprehensive diagnostic approaches, including bone marrow examination and molecular diagnostics, are essential for accurate diagnosis and timely initiation of appropriate treatment, ultimately improving patient outcomes and minimizing disease complications.

Borderline lepromatous leprosy: A case report

Rationale: Lepromatous leprosy can have many atypical presentations, obscuring early diagnosis. We present a case of lepromatous leprosy, presenting with atypical features, which made a diagnostic dilemma. Patient concerns: A 48-year-old man presented with bilateral lower limb oedema and scaly “ichthyosis like” skin rash in both hands and feet, hepatosplenomegaly and pancytopenia, over a course of three months, without any classical features of leprosy. A skin biopsy revealed an unexpected diagnosis of borderline lepromatous leprosy. Diagnosis: Lepromatous leprosy. Interventions: Multi-drug regimen treatment with rifampicin, dapsone and clofazimine for lepromatous leprosy. Outcomes: The patient made a good clinical recovery. Lessons: In endemic settings, clinicians should be aware of similar atypical manifestations of leprosy to face the global challenge of eradicating this chronic deforming disease.

Multibacillary lepromatous leprosy detected in Olmedo, Ecuador. Case report

Introduction: hansen's disease or leprosy is an infectious disease caused by Mycobacterium leprae, which mainly affects the skin, peripheral nerves and mucosa of the upper respiratory tract. It has a chronic course as old as humanity itself.Clinical case: the clinical case of a 51-year-old male patient, native and from the Olmedo canton, province of Manabí, with a farmer occupation, who began to present in November 2008 with macular, hyperchromic skin lesions, which progressed, is presented. to multiple nodules, located in the lower limbs and then spreading to the upper limbs, thorax and abdomen, neck and face. The set of clinical parameters and positive biopsy results allowed the case to be classified as Lepromatous Leprosy (multibacillary). Triple multitherapy (Dapsone, Rifampicin, Clofazimine) was prescribed, showing an improvement in the number and size of the lesions at the end of therapy.Discussion: this is the first clinical case of lepromatous leprosy detected in the Olmedo canton, Manabí province, Ecuador. Due to the novelty in the territory, the patient had this condition for years without being diagnosed or treated adequately and even once under treatment, there were delays in acquiring the medications that extended their application from 12 months to a period of 25 months.Conclusions: the clinical case presented highlights that Hansen's Disease is an emerging health problem in the Olmedo canton, highlighting the need to make sustained efforts for its identification, treatment and prevention in the territory

Bilateral Ocular Leprosy An Effect By Erythema Nodusum Leprosum : A Case Report

Introduction : Leprosy or Hansen’s disease is an infection caused by Mycobacterium leprae that primarily affects the skin, the peripheral nerves and the eyes, causing chronic granulomatous inflammation.
 Case Illustration : We present a case of lepromatous leprosy with erythema nodosum leprosum of a 47 years old man with bilateral and asymmetrical ocular complications. One year ago patient consumed multidrug therapy for leprosy for one year but didn’t finish the medication. On the right eye diagnose with chronic anterior and intermediate uveitis, on the left eye with panuveitis. Best corrected visual acuity (BCVA) was 2/60 for right eye and light perception for left eye. Intraocular pressure were within normal limits. Madarosis and corneal hypoesthesia were found on both eyes. On the right eye was found cells, synechia anterior and posterior, iris pearls and vitreous haze. On the left eye was found plasmoid iridocyclitis and vitreous opacities from USG. Slit skin smear (SSS) result positif acid fast bacilli (AFB) dan granular. Patients were treated with multidrug therapy for leprosy, topical antibiotics, atropine and steroids, oral antibiotics and treatment from a dermatologist.
 Discussion : The diagnosis of lepromatous uveitis (LU) in this patient is made through skin tissue biopsy and ophthalmological examination. The effective management of ocular leprosy depends on early diagnosis and appropriate treatment. Hence it is imperative for ophthalmologist to recognize the ocular clinical signs associated with leprosy.
 Conclusion : Most blindness and impaired vision resulting from leprosy is preventable. A multidisciplinary approach is to be taken in order to improve the prognosis.

Genomic characterization of Mycobacterium lepromatosis from ENL patients from India

BackgroundLeprosy is caused by Mycobacterium leprae and Mycobacterium lepromatosis. Both organisms cannot be cultured in vitro. M. lepromatosis was found to be associated mainly with diffuse lepromatous leprosy and with Lucio's phenomena initially. Later, M. lepromatosis was observed in borderline leprosy cases (BL), lepromatous leprosy cases (LL) and leprosy reactional cases (T1R and ENL). Although many cases are being reported with similar clinical features like Lucio phenomenon in India but M. lepromatosis was not isolated from these cases. The aim of this study was to screen MB patients and patients with type 2 reaction for the presence of M. lepromatosis. MethodologyWe recruited a total of 75 multibacillary leprosy cases (45 MB cases without reaction and 30 type 2 reaction (ENL) cases) from TLM hospitals Purulia (West Bengal), Barabanki (Uttar Pradesh), Shahdara (Delhi) and PGIMER (Chandigarh), India. Punch biopsies of 5 mm were collected in 70% ethanol from all the study subjects. DNA was extracted followed by Hemi-nested PCR targeting 16S rRNA gene specific for M. lepromatosis. Further, PCR products were processed for Sanger sequencing for an absolute confirmation of M. lepromatosis. Whole genome sequencing was done to confirm the presence of M. lepromatosis. ResultWe observed presence of M. lepromatosis in 4 necrotic ENL patients by heminested PCR. There was 100% 16S rRNA sequence similarity with M. lepromatosis FJ924 in one case, 98.96% in two cases and in one case it was 90.9% similarity by nucleotide BLAST (BLASTn) by using the NCBI website. On the basis of Sanger sequencing, we noted presence of M. lepromatosis in 3 necrotic ENL patients as one sample only gave 90.9% similarity by BLASTn. On the basis of de novo assembly and genome obtained, only one sample S4 with a 2.9 mb genome size was qualified for downstream analysis. Sixteen M. lepromatosis- specific proteins were identified in this case and the closest species was M. lepromatosis strain FJ924 based on whole genome level phylogeny. ConclusionThese results provide valuable insights into the prevalence of M. lepromatosis in ENL patients in different regions of India and contribute to our understanding of the genetic characteristics of this pathogen in the context of leprosy.

Reverse Koebner phenomenon in erythema nodosum leprosum.

Erythema nodosum leprosum (ENL) is an immunologically mediated phenomenon complicating the course of leprosy. Reverse Koebner phenomenon is the term used to describe the sparing of previously injured or diseased skin by new skin lesions of the disease. A middle-aged woman with a known case of lepromatous leprosy for the past year presented with an eruption of reddish painful nodules over her body. The lesions were found to characteristically spare the sites of previous scars. This sparing phenomenon of previous scar sites has been termed reverse Koebner phenomenon, a site of the body that offers greater resistance than the rest of the body to the onset of the disease, seen in various diseases, but it has never been described in ENL. This sparing of scar sites in ENL can be attributed to reverse Koebner phenomenon.

Immunoexpression of TGF-β: An utility marker in hansen’s disease

TGF-β is a pleiotropic cytokine that deploys several functions on different types of cells. In the lepromatous (LL) form of Leprosy, there is predominance of M2 macrophages, which induce the production of growth factors, such as TGF-β which is important for the mechanisms that cause apoptosis and healing. To study the immunoexpression of TGF-β in Hansen’s disease and to assess the severity of infection with potential response to treatment. The present study was carried out in 45 patients of Hansen’s disease after a detailed history and thorough physical examination performed in every subject and punch biopsies were performed. The specimens were fixed, paraffin embedded and sections of 3-5 microns thickness were cut and stained with hematoxylin and eosin stains. Additional sections of 3-4 microns thickness were cut and immunohistochemical staining by TGF-β antibody was performed. Of the 45 cases of Hansen’s disease, most of the cases were of Borderline Tuberculoid and Borderline Lepromatous, constituting 14 (31.1%) cases each, followed by 9 (20.0%) cases of Lepromatous Leprosy. Maximum cases, 12 (26.7%) each with intense reaction were of Borderline Tuberculoid and Borderline Lepromatous, followed by 6 (13.3%) cases of Lepromatous Leprosy. Most of the cases, 9 (20.0%) were of Borderline Lepromatous category with highest proportion score, followed by 7 cases (15.6%) of Borderline Tuberculoid. Highest number of cases, 9 (20.0%) with high immunoreactivity score were in Borderline Lepromatous, whereas most of the cases, 7(15.6%) with low immunoreactivity score were in Borderline Tuberculoid. The immunoexpression of TGF-β was more intense in lepromatous side of the spectrum as compared to the tuberculoid, which indicates the severity of the disease with less cure potential.

Histopathological Evaluation of Skin Biopsies of Leprosy at a Tertiary Care Centre of Western Rajasthan, India: A Cross-sectional Study

Introduction: Leprosy is a slowly progressive chronic granulomatous disease caused by Mycobacterium Leprae (M. leprae) and predominantly affects skin and peripheral nerves. Leprosy is a leading cause of physical disability in India and poses a major public health challenge for the country. Histopathological evaluation and demonstration of Lepra bacilli by special stain is gold standard for definitive diagnosis and subtyping of leprosy. Aim: To study the common histological subtypes of leprosy on the basis of microscopic features and bacteriological index. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Dr. S.N. Medical College, Jodhpur, Rajasthan, India. The duration of the study was two years and 11 months, from January 2019 to December 2021. A total of 55 skin biopsies which were histologically diagnosed as different types of leprosy were included. Patients data of age, gender, skin examination and other investigations were collected from the requisition forms and analysed. After proper fixation and processing of biopsy samples, Haematoxylin and Eosin (H&E) stained sections were examined for epidermal atrophy, presence of grenz zone, granulomas, infiltrates of lymphocytes, histiocytes, foam cells, infiltration of nerves and adnexa. The sections stained with Fite-Faraco stain were studied for the assessment of bacteriological index. On the basis of microscopic features, cases were categorised into tuberculoid leprosy, borderline tuberculoid leprosy, indeterminate leprosy, borderline leprosy, lepromatous leprosy and histoid leprosy as per Ridley-Jopling classification and percentage is calculated for each category. Data was entered and analysed by using Microsoft Excel version 2008 and Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study participants was 39.6 years. Male to female ratio was 2.92:1. There were 33 (60%) cases with erythematous lesions followed by 15 (27.27%) hypopigmented lesions and 7 (12.73%) nodules. Out of 55 there were 21 (38.18%) cases of tuberculoid leprosy followed by 11 (20%) cases of borderline tuberculoid leprosy, 8 (14.55%) cases of indeterminate leprosy, 6 (10.91%) cases of borderline leprosy, 5 (9.09%) cases of lepromatous leprosy and 4 (7.27%) cases of histoid leprosy. Bacteriological index was negative in 35 (63.64%) cases followed by 2+ in 6 (10.91%) cases, 5 (9.09%) had index of 4+, 4 (7.27%) cases had index of 3+, 3 (5.45%) had index of 1+, and 1 (1.82%) case had index of 5+ and 6+ each. Conclusion: Skin biopsy is easy, simple, inexpensive and outpatient procedure which provides adequate material for confirmation of the clinical diagnosis and further management. Histopathological examination including microscopic features of H&E stained sections, along with assessment of bacteriological index on Fite-Faraco stained sections remain the gold standard for diagnosis and subtyping of leprosy cases.

Changes in plasma levels of endocrine hormones in lepromatous leprosy patients

BackgroundLeprosy affects various endocrine glands and causes disorders in internal organs in addition to the skin and peripheral nerves. These disorders are often silent and remain undiagnosed or underreported. In particular, patterns of hormone changes during leprosy, especially in lepromatous leprosy (LL) patients, are often associated with dysregulation of different endocrine and sex hormones. The aim of this study was to assess changes in four endocrine hormones — namely cortisol, dehydroepiandrosterone (DHEA), growth hormone (GH), and leptin — among LL patients compared with apparently healthy controls. MethodIn total, 80 plasma samples were systematically retrieved from a biorepository at the Armauer Hansen Research Institute (AHRI), based on quality, adequacy of sample volume, and appropriateness of linked clinical and sociodemographic data. Forty of the samples were obtained from LL patients (cases) and the remaining 40 from apparently healthy controls. Enzyme-linked immunosorbant assay (ELISA) was used to quantify levels of DHEA, cortisol, GH, and leptin hormones in the plasma samples. Data were analyzed using non-parametric statistics and the Mann–Whitney U-test (GraphPad Prism version 7.01). A p-value < 0.05 was considered statistically significant. ResultsPlasma levels of cortisol concentration were significantly higher in LL cases (median = 111.4 ng/ml, range = 20.54–525.7) compared with healthy controls (median = 51.98 ng/ml, range = 3.805–328.4) (p = 0.003). Levels of GH and leptin were significantly lower in LL cases compared with healthy controls (median values for GH = 1.01 µIU/ml, range = 0.4625–86.82 and 2 µIU/ml, range = 0.5838–63.36, respectively (p = 0.022); median values for leptin = 891 pg/ml, range = 728.4–21816 and 5147 pg/ml, range = 730.4–52747, respectively (p < 0.0001)). There was an apparent reduction in the plasma levels of DHEA among LL cases compared with healthy controls (p = 0.297), although this difference was not statistically significant. ConclusionAlterations in levels of endocrine hormones seen in LL patients reflect clinical and immunological conditions during lepromatous leprosy. However, large-scale studies are warranted to determine how leprosy causes such alterations in hormones and the interplay between endocrine hormones and the immune system during leprosy disease.

EXPRESSION OF S100 PROTEIN AND CD1A MARKER IN LESIONS OF LEPROSY

Background: Leprosy rst described in ancient Indian texts is a nonfatal, chronic infectious disease caused by Mycobacterium leprae. Histological diagnosis is deemed the gold standard for diagnosis of leprosy. Immunohistochemical markers play an important role in monitoring of progression of the disease and effect of treatment. SlOO protein was produced robustly and continuously in macrophages from Lepromatous leprosy patients' lesions. Distinguishing characteristics of LCs suggested that their expression of langerin may enable them to capture certain antigens when they reach the epidermal layers, and that at least some of these antigens might be delivered to CD1a-restricted T cells. In the present study, both S100 protein and CD1a expression has been studied on 38 cases of leprosy cases for assessing the hypothesis. Objectives: Histopathological differentiation of types of leprosy and correlate the expression of S100 protein and CD1a antibody. This study Methodology: was conducted in Department of Pathology, Gandhi Medical College, &amp; Associated Hospitals, Bhopal between 1st January 2020 to 30th June 2021. Skin biopsies received in Department of Pathology, Gandhi Medical College and Hamidia Hospital, Bhopal. Information was taken from requisition forms received in Department of Pathology. History of cases was also taken through case les and interview. The samples were processed for histopathology evaluation and immunohistochemistry staining for S100 and Cd1a. In Results: our study, out of 38, 52.63% cases were diagnosed to be Indeterminate leprosy followed by 23.68 cases of Tuberculoid leprosy , Borderline tuberculoid and Lepromatous leprosy cases were 13.16% and 10.53% in numbers respectively. Cross tabulation for S100 positivity as per histological diagnosis showing that all Lepromatous leprosy cases gave positive expression for this IHC marker whereas all Tuberculoid leprosy cases were negative. Out of 5 cases of BT, 3 were S100 positive and 2 out of 20 cases of IL gave positivity. All Tuberculoid cases (except 1) gave positivity for CD1a and all Lepromatous cases were negative. Out of 20 IL cases, 9 gave positivity. All 5 BT cases gave positivity. Owing to treatment, early or late presentations, Summary: immunological status of the host, histo-morphology may vary as well, however, it remains to be the gold standard of diagnosis. Our study evaluated the role IHC markers namely S100 and CD1a as an ancillary technique to support histopathological diagnosis and guide early and more specic diagnosis in early leprosy cases, assess host's immune status as well as hint towards transition through the spectrum.

Mycobacterium leprae and Mycobacterium lepromatosis Infection: a Report of Six Multibacillary Cases of Leprosy in the Dominican Republic.

The causative agents of leprosy are Mycobacterium leprae and M. lepromatosis. Mycobacterium lepromatosis was found in 2008 to cause diffuse lepromatous leprosy in Mexican patients. This study aimed to identify M. leprae and M. lepromatosis in paraffin-embedded skin samples from Caribbean patients with leprosy. A total of six skin samples were obtained from the Dominican Republic. All cases presented the multibacillary form; five were nodular lepromatous leprosy, and one was borderline lepromatous leprosy. All patients received multidrug therapy. Molecular identification was achieved using the M. leprae-specific repetitive element for M. leprae and the hemN gene for M. lepromatosis. Mycobacterium leprae was identified in two lepromatous leprosy cases, and one borderline lepromatous leprosy case; M. lepromatosis was found in one nodular lepromatous leprosy case. Both Mycobacterium species were present in two nodular lepromatous leprosy cases. This is the first report of M. lepromatosis in the Dominican Republic.

False Positive Reaction to Vdrl Test with Prozone Phenomenon in a Case of Lepromatous Leprosy

Abstract The venereal disease research laboratory (VDRL) test, a nontreponemal test for syphilis, may under a certain set of conditions give false positive results in patients who are not infected with Treponema pallidum. A false positive reaction is defined as a positive reaction to nontreponemal tests, and a negative reaction to treponemal tests, in the serum of a patient who has no history or clinical evidence of syphilis or other treponematosis. A prozone phenomenon in nontreponemal tests is seen largely with secondary syphilis due to high-titer samples that show nonreactive results unless the specimens are diluted. We report here perhaps the first case of lepromatous leprosy, which had a false positive reaction to the VDRL test with the prozone phenomenon. The case initially presented to the outpatient clinic with complaints of epistaxis with nasal stuffiness. The finding of septal perforation on nasal endoscopy is what led to the initial suspicion of syphilis and the subsequent syphilis workup. It was only when the false positive reaction to VDRL test with the prozone phenomenon was noted that the search for other causes was made, which eventually lead to the diagnosis of lepromatous leprosy.

Histopathologic Study of Hansen’s Disease

Introduction: Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae. Accurate clinical and histopathological diagnosis forms the backbone for appropriate treatment and preventing deformities and drug resistance. Several studies have been conducted on clinical presentation of leprosy however there is a paucity of leprosy related histopathological data from Nepal. Objectives: The objectives of this study were to evaluate histopathological features of leprosy in skin biopsies, categorize them into various types based on Ridley Jopling classification and to correlate with clinical presentations. Methodology: Ninety six skin biopsies histologically diagnosed cases of leprosy from 16th October 2020 to 15th April 2021 were included in the study. Ethical consent was taken from the Institutional Review Committee of KMCTH (Ref.:011020202005). Hematoxylin and Eosin stain was used to study histopathological details. Wade- Fite stain was used to evaluate Bacillary index. The lesions were classified as per the Ridley-Jopling classification. Histopathologic findings were correlated with clinical diagnosis. Results: Male to female ratio of patients was 2.4:1. Most of the cases were seen in the third decade of life (39.6%). Most of the cases presented clinically as papules, nodules and hypoaesthetic patches involving predominantly extremities of the body. Commonest histological diagnosis was Borderline Tuberculoid (BT) leprosy (31/96). All cases of Lepromatous leprosy (LL) showed Acid Fast Bacilli on Wade- Fite stain. Tuberculoid leprosy cases showed granulomas and perineural involvement. Conclusion: Histopathological examination remains the gold standard for definite diagnosis and categorization of Hansen’s disease.

Single Plaque Lepromatous Leprosy Presenting as Granuloma Annulare

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, primarily affecting the peripheral nerves and skin. The clinical presentation of leprosy is highly variable, depending on the immune status of the individual. Based on the Ridley–Jopling classification, the clinical spectrum ranges from tuberculoid to lepromatous leprosy (LL). In all its stages, it can mimic various other conditions. Early and accurate diagnosis of leprosy is crucial because late recognition may give rise to permanent deformity resulting from the disease. Here, we report a case of LL clinically presenting as granuloma annulare in a 75-year-old man, which was diagnosed and confirmed by histopathology.

P.137 A case of leprosy in the UK

Introduction: Leprosy is a multi-system disease caused by Mycobacterium leprae. Whilst uncommon in the developed world, cases continue to rise in developing nations with up to 200,000 new cases reported annually. 1We report a case of lepromatous leprosy in a parturient residing in Scotland. Case Report: A 26-year-old primigravida presented in early pregnancy following a history of nosebleeds and widespread rash. The patient was a sickle-cell carrier but was otherwise well with no allergies. A diagnosis of lepromatous leprosy with erythema nodosum reaction was made and treatment commenced with prednisolone and combination therapy with rifampicin, clofazimine and dapsone. The pregnancy was complicated by anaemia and thrombocytopaenia with mild splenomegaly. Anaemia was thought to be secondary to Dapsone-related haemolysis, and thrombocytopaenia was thought most likely to be gestational. She developed neuropathic leg pain and hypoaesthesia but this resolved during the pregnancy. Renal and liver function remained normal and there were no symptoms or signs of autonomic dysfunction with normal postural blood pressure readings and normal ECG. After multi-disciplinary discussion, induction of labour was planned due to concerns over fetal growth. The patient was screened for SARS-CoV-2 and this was positive, though the patient remained asymptomatic. The patient was not considered to be infectious and standard infection control procedures were observed. Anaesthetic options for analgesia in labour and anaesthesia for potential operative delivery were discussed at several occasions during pregnancy and ”OAA Labour Pains” translated information sheets were given to the patient. Following induction of labour, the patient had a spontaneous vaginal delivery with no anaesthetic intervention required. Discussion: Leprosy is uncommon in developed nations but may occur in the UK as the population becomes more diverse. Leprosy raises many potential challenges for the anaesthetist including;cutaneous changes (which may be of particular significance if occurring over sites of intravenous access or lower lumbar region), neuropathies, myopathies, autonomic dysfunction, haematological derangements (including anaemia, thrombocytopaenia and agranulocytosis) and liver and renal impairment. Drug therapies for leprosy may in themselves be associated with blood dyscrasias, hepatitis, psychosis, and peripheral neuropathies. Anaesthetic management should be informed by the presence of any complications, most notable thrombocytopaenia or peripheral neuropathies. The possibility of autonomic dysfunction should be considered regardless of which anaesthetic modality is chosen and care taken to actively manage hypotension. The patient’s SARS-CoV-2 status was a further factor influencing the risk-benefit assessment of anaesthetic options in this case.

Clinicopathological study of lepromatous leprosy and histoid leprosy in a tertiary care institute

Background: Lepromatous leprosy is a clinical course seen in patients with inefficient cellular immunity against Mycobacterium leprae, resulting in anergy. A highly bacilliferrous type of lepromatous leprosy is histoid leprosy. Histoid leprosy was initially reported to manifest after the failure of long-term dapsone monotherapy, irregular therapy, or inadequate therapy. However, it is now well known that histoid leprosy develops de-novo as well. This study was undertaken to know the incidence and clinicopathological characteristics of lepromatous leprosy and histoid leprosy.Materials and Methods: This was a combined (both retrospective and prospective) study of lepromatous and histoid Leprosy, undertaken in the Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi, over 42 months from January 2013 to June 2016.Results: Out of the 16 clinically diagnosed lepromatous leprosy cases, only 5 were histologically proven to be the same. Of the seven clinically diagnosed histoid leprosy cases, 4 were histoid leprosy on histopathology and the remaining 3 were lepromatous leprosy. All 4 patients of histoid leprosy were cases of De- Novo histoid leprosy. The commonest skin lesion encountered were erythematous patches (9/16) in lepromatous leprosy and nodules (5/7) in histoid leprosy.Conclusions: Lepromatous leprosy when diagnosed in an early stage, interrupts the epidemiological chain and avoids the associated disabilities and psychological effects for the patient and family. Histoid leprosy is a rare entity that can also present with no history of prior anti-leprosy treatment, the diagnosis of “de-novo histoid leprosy” should be kept in mind.

Dermatoscopy and Clinicopathological Correlation in Different Spectrum of Leprosy

Background: Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermatoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the skin with the visualization of morphologic features that are invisible to the naked eye. In our study, we aim to describe the dermatoscopic features of all types of leprosy and correlate with clinical and histopathological findings. Materials and Methods: A prospective observational study was done on all the leprosy patients attending OPD over a period of 1 year. The study patients were categorized as per Ridley–Jopling classification. The lesions of different types of leprosy were photographed and evaluated by dermatoscopy and biopsied. Results: A total of 60 patients (34 males and 26 females) were taken under the study. Of 60 patients, 6 cases of tuberculoid leprosy, 22 cases of borderline tuberculoid (3 with Type 1 reaction), 16 cases of borderline lepromatous, 12 cases of lepromatous leprosy (5 with Type 2 reaction), and 4 cases of Histoid leprosy. The dermatoscopic features seen are yellowish-orange areas and vascular structures such as linear branching vessels and crown vessels. Broken pigment network and white chrysalis like areas are also seen. Absence or diminished hair follicles and eccrine duct openings are seen in tuberculoid spectrum. Scaling and follicular plugs are seen in type 1 reaction. Conclusion: Yellowish-orange areas and vascular structures are the common dermatoscopic features seen in leprosy. Broken pigment network and paucity of appendageal structures are other features seen.

Analysis of histomorphological study in Hansen’s disease: A hospital based study done in rural population

Leprosy, also known as Hansen’s disease is a chronic infectious disease caused by Mycobacterium Leprae. It still continues to be a major public health problem in India. AIM: The study was aimed at analysing the histomorphological features of leprosy in skin biopsies and based on histological findings they were categorised according to Ridley-Joplings classification. Clinical correlation was also done wherever possible. Materials and methods: After adequate fixation of skin biopsies with 10% formalin, routine processing was done and tissue embedded in paraffin section of 5µ thickness and then stained with Hematoxylin and Eosin (H&E) and Fite-Faraco stain, subsequently studied under microscope. Results: Total of 35 skin biopsies were studied, with the mean age of presentation ranging from 14-72 years, showing male predominance. Boderline tuberculoid (37.14%) was the most common type. Atrophic epidermis was seen only in 9 cases but Grenz zone was present in all 12 cases of Lepromatous leprosy. Epithelioid granuloma is the commonest finding in Boderline Tuberculoid type. Clinico histomorphological correlation was made in 23 cases and discoherence was found in remaining 12cases. Conclusion: Correlation of clinical and histopathological features along with bacteriological index plays a pivotal role for accurate typing and for prognostication. Clinicopathological concordance is highest in polar forms, and being least in Indeterminate Leprosy (IL).

Report of two cases of lepromatous leprosy at an early age

Leprosy is an infectious disease that has a broad spectrum of clinical manifestations. Lepromatous leprosy has a deficient cellular immune response and high bacillary multiplication. It has epidemiological importance, as it is the most contagious clinical form of the disease. Its manifestation in children and adolescents is unusual. In the present study, we report two cases of leprosy at an early age, manifesting the lepromatous clinical form, highlighting the auricular involvement in one case. Early diagnosis is an essential tool to avoid deformities and deficiencies.