Histoid Leprosy Research Articles

“Histopthological Spectrum Of Leprosy In A Tertiary Care Centre”

Background: Leprosy affects skin and peripheral nerves, muscles, eyes, bones, testis and internal organs. Histopathology and demonstration of lepra bacilli is a vital role to supplement clinical examination and diagnosis for correct classification and therefore for patients treatment. Aim- To study the Histopathology spectrum of Leprosy in a tertiary care centre. Materials &Methods: All the skin biopsy with clinically suscipious of leprosy and sent for histopathological examination during the year Jan 2020 to Dec 2024 were included in the study. Results: A total of 60 cases were studied out of them 61% are male and 39% are female. With M:F ratio1.56: 1, majority of them belongs to 41-50 age group. The commonest histological type was borderline TB leprosy followed by Borderline lepromatous leprosy, least common cases were of lepromatous leprosy and histoid leprosy. Conclusion: Histopathological examination is the important investigation for accurate diagnosing and typing of leprosy

Unveiling the clinico-dermoscopic and histopathological correlation of histoid leprosy: A case series

Unveiling the clinico-dermoscopic and histopathological correlation of histoid leprosy: A case series

Histoid leprosy.

Histoid leprosy.

A case report of de novo histoid leprosy in a Nigerian male: A diagnostic dilemma.

Histoid leprosy is an uncommon variant of lepromatous leprosy. It poses a diagnostic challenge because of its distinctive clinical and histopathological features. It presents as smooth papules and nodules that rarely ulcerate. We present the case of a 22-year-old Nigerian man with a 2-year history of multiple, dome-shaped papules and nodules on the skin with necrotic centres. General examination showed right axillary lymphadenopathy, non-pitting oedema, foot ulcer, and glove and stocking sensation loss. Despite previous misdiagnoses, histopathological examination showed dermal expansion by histiocytes arranged in a storiform pattern. Slit skin smear yielded abundant bacilli. The patient was started on WHO multidrug treatment, resulting in the improvement of his lesions. This case emphasises the importance of increased awareness of this rare presentation of leprosy.

De novo Histoid Leprosy of face mimicking Lupus Miliaris Disseminatus Faciei: An uncommon presentation

Background: Background: Histoid leprosy is a rare variant of lepromatous leprosy with distinct clinical features and characteristic histopathology. It is diagnosed using classical histopathological findings and Fite staining, distinguishing it from dermatofibroma and neurofibroma using factor XIIIa and S100 on immunohistochemistry. A middle-aged female presented with facial lesions mimicking Lupus Miliaris Disseminatus Faciei (LMDF). Case report: A 35-year-old female with facial lesions for two months, previously treated with oral isotretinoin for acne vulgaris, presented with multiple papules. Differential diagnoses included lupus miliaris disseminatus faciei (LMDF), multiple trichoepitheliomas, sarcoidosis, and post kala azar dermal leishmaniasis (PKDL). A slit skin smear examination revealed numerous acid fast bacilli, longer than normal lepra bacilli, and tapering ends. A punch biopsy revealed a grenz zone, an atrophic epidermis, sheets of elongated epithelioid cells with histoid habitus, and an inflammatory infiltrate in the dermis. A Fite stain was positive, confirming histoid leprosy. Multidrug treatment was initiated with rifampicin, clofazimine, and dapsone. LMDF is a rare dermatoses with asymptomatic papular eruptions over the face around the eyelids and epitheloid granuloma with caseous necrosis in the dermis. Conclusion: Several atypical presentations of histoid leprosy have already been described like Erythema nodosum like and figurate lesions. But LMDF like lesions is a rare presentation and it should be added to various morphological presentations of histoid leprosy.

Diagnosis and Treatment of Leprosy in Taiwan during the COVID-19 Pandemic: A Retrospective Study in a Tertiaty Center.

Currently, over 200,000 new cases of leprosy are reported annually worldwide. Although leprosy was thought to have been eradicated in Taiwan, a few new cases still occur annually. Protean clinical manifestations of leprosy and immunological reactions result in delayed diagnoses. In addition, drug-resistant leprosy is emerging and poses treatment challenges. In this retrospective study, we collected and analyzed the clinicopathological features, leprosy type, treatment response, and relapse rate of patients with leprosy in our hospital between January 2009 and November 2022. We found that 54% of patients were Indonesian, and borderline lepromatous leprosy was predominant (39%); moreover, histoid leprosy and the Lucio phenomenon were also reported. Polymerase chain reaction analysis identified four positive cases, including a dapsone-resistant (4%) case. Our findings indicated good control of leprosy and a lower rate of dapsone resistance than that reported by the World Health Organization (4% vs. 13%) from 2009 to 2015. We found that the patient profile in terms of the treatment duration, recurrence rate, systemic symptoms, and neurological symptoms did not differ between before and during the pandemic. We report the recent advances in leprosy diagnosis, drug-resistant gene mutations, post-exposure prophylaxis, vaccination, and the effect of coronavirus disease 2019 on leprosy to facilitate updated leprosy diagnosis and management.

Trans-epidermal elimination of lepra bacilli in histoid leprosy with ulceration: An uncommon presentation

Trans-epidermal elimination of lepra bacilli in histoid leprosy with ulceration: An uncommon presentation

Histoid Leprosy with Localised Facial Lesions: A Unique Presentation.

Histoid Leprosy with Localised Facial Lesions: A Unique Presentation.

Histoid leprosy, an unusual variant of leprosy − review of literature

Histoid leprosy is a rare variant of leprosy with distinctive immunological, clinical, microbiological, and histological characteristics first described by Wade in the year 1963. This is usually reported following dapsone monotherapy, irregular or improper therapy, and rarely de novo. Early diagnosis and treatment of histoid is important as it might serve as a reservoir and source of community spread of leprosy. In this article, we highlight the important aspects of clinical manifestations, immunological, histological, bacteriological, and management aspects of histoid leprosy.

A RETROSPECTIVE STUDY OF HISTOMORPHOLOGICAL SPECTRUM OF HANSEN’S DISEASE IN A TERTIARY CARE CENTRE OF BARABANKI AREA

Objectives: Hansen’s disease is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Early detection is essential to prevent the disease’s spread and disability. Due to the multitude of morphologies, it may be difficult to accurately diagnose certain cases based solely on clinical signs; therefore, histopathology is crucial for definitive diagnosis. The study aims to investigate the various histological forms of leprosy over a year in a tertiary care hospital. Methods: It was a retrospective study that included 25 leprosy cases that were clinically and histopathologically diagnosed from July 2021 to August 2022 in a tertiary care center. Results: The majority of the cases were from the second decade with the male predominance of the cases (M:F=1.5:1). According to histomorphology, tuberculoid leprosy was the most common type (36%), followed by borderline tuberculoid (24%), borderline lepromatous (16%), lepromatous leprosy (8%), borderline leprosy (8%), histoid leprosy (4%), and indeterminate leprosy (4%). Ziehl–Neelsen staining for acid-fast bacilli demonstrated positivity in 8 cases. Conclusion: As the clinical spectrum of leprosy is diverse, histopathology is the gold standard for the diagnosis and a key tool in obtaining a conclusive diagnosis.

Histoid leprosy complicated by erythema nodosum leprosum mimicking connective tissue disease.

Erythema nodosum leprosum (ENL) is an immunological complication of leprosy seen in 50% of lepromatous and 10% of borderline lepromatous leprosy. It usually presents as a multisystem disease with papulo-nodular skin lesions and fever. Arthralgia or arthritis is a common initial presentation of erythema nodosum leprosum. Pure rheumatologic presentation of lepromatous leprosy complicated by erythema nodosum leprosum is extremely rare, mimics connective tissue disease and is treated with steroids.

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.

Tumor-like lesions of histoid leprosy in an elderly male

Tumor-like lesions of histoid leprosy in an elderly male

Verrucous Haemangioma with Histoid Leprosy: A Case Report

Verrucous Haemangioma (VH) is a rare, congenital vascular malformation of cutaneous and subcutaneous tissue. It usually presents as macular lesion at birth which progresses with age, and may become bluish papules, nodules, and warty plaques. Linear presentation of this disease is even rarer. Here the present case report presents a case of a 30-year-old male patient with multiple raised erythematous hyperkeratotic papules and plaques over right forearm since birth which was arranged in a linear pattern.The patient also had asymptomatic papules on right thigh and lower back region, associated with sensory loss and peripheral nerve thickening. Dermoscopy of forearm showed reddish-blue lacunae, alveolar pattern, and whitish veils. Colour Doppler showed intradermal dilated venous channels with thrombosis which was suggestive of haemangioma. Histopathological examination confirmed the diagnosis of linear VH on forearm and slit skin Ziehl-Neelsen staining was suggestive of histoid leprosy. Linear VH is a rare congenital venous malformation, progresses proportionately with age. Dermoscopy can help in early diagnosis of vascular lesions. Complete surgical excision is the treatment of choice.

LEPROSY A CHANGE IN PROFILE?

Leprosy has been ofcially eliminated from India since December, 2005; still there are districts and blocks reporting high prevalence indicating ongoing transmission. Thepresent study aimed at determining the current situation/scenario of leprosy in a tertiary level hospital in Kolkata.It is a cross-sectional observational study carried out on patients diagnosed and registered in the leprosy clinic (May 2018-May 2020).Data regarding clinical features, histopathological diagnosis and treatment, reactions was analyzed. Skin biopsies were taken in all cases and slit skin smear was done. The biopsies and slit skin smear were evaluated for the type of pathology and acid fast bacilli (AFB) status. A total of 58 patients were registered over 8months period, with M: F (4.8:1). 5child cases were reported, 44 (75.86%) were new cases, 14 (24.14%) were defaulter. Slit skin smear showed 37 (63.79%) cases were multibacillary (MB). Lepromatous leprosy (LL) 28 (48.28%) was the most frequent morphologic type followed by borderline tuberculoid (BT) 12 (20.69%) andtuberculoid leprosy 9 (15.52%) borderline lepromatous(BL) 4 (6.89%) cases, 5 (8.62%) case of histoid leprosy. 9 (15.51%) presented with each type 1 and 5 (8.62%) cases with type 2Erythema NodosumLeprosum (ENL) reaction.Our studyoffers insight into the current status of the disease in the area of otherwise low prevalence. It is seen that despite statistical elimination, lepromatus leprosy, leprosy reactions are commonly seen as presenting features. It highlights the need for continuation of targeted leprosy control activities and active case detection.

A Case of Histoid Leprosy Presenting as Immune Reconstitution Inflammatory Syndrome (IRIS) in a Patient of Human Immunodeficiency Virus (HIV) Infection on Highly Active Retroviral Therapy (HAART).

A Case of Histoid Leprosy Presenting as Immune Reconstitution Inflammatory Syndrome (IRIS) in a Patient of Human Immunodeficiency Virus (HIV) Infection on Highly Active Retroviral Therapy (HAART).

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study

Leprosy, an insidious infectious granulomatous disease, is diagnosed traditionally through clinical examination coupled with skin smears and histopathology. It has myriad clinical presentations that pose diagnostic challenges. Lately, dermoscopy has emerged as a rapid, noninvasive diagnostic modality for many dermatoses. We evaluated the dermoscopic findings of various manifestations of leprosy and correlated them with clinical and histopathological features. This prospective, cross-sectional study was conducted in our skin outpatient department for a period of 1 year. Patients newly diagnosed as having leprosy or those undergoing leprosy treatment for less than 6 months were included. The most representative lesion was dermoscopically evaluated and later biopsied. We included 73 patients in the study. Results indicated an obvious correlation between dermoscopic findings and histopathology. We noted orangish yellow and white structureless areas, steadily throughout the spectrum, depicting dermal granuloma. Additionally, we observed focal vascular structures such as branching, linear, and crown vessels that result from the pressure of granuloma pushing the dilated vessels upwards. The relative absence of skin appendages aided in differentiating leprosy from other granulomatous disorders. Novel findings of our study were the detection of a branch-like pattern of clofazimine-induced pigmentation on dermoscopy and orange globules on onychoscopy. Other unique findings included violaceous structureless areas, characteristic large telangiectatic vessels, follicular plugging, star-shaped silvery-white scaling, and white globules in type 1 reaction; white shiny steaks were observed in patients with borderline lepromatous leprosy, and central white dots and keratotic plugs were observed in patients with histoid leprosy. Dermoscopy, as a noninvasive modality, could aid in the quick diagnosis of leprosy and should be used as a handy tool to complement other investigative tools for this disease.

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.

A STUDY OF CONCORDANCE BETWEEN CLINICAL AND HISTOPATHOLOGICAL DIAGNOSIS IN CASES OF LEPROSY WITH RELEVANCE TO THERAPY

AIMS AND OBJECTIVES:To achieve the goal of WHO new global strategy of 2016-20 to decrease the case load, early and proper diagnosis for treatment and avoiding disability. Examination of a biopsy specimen of skin or nerve biopsies for histopathology can be a valuable aid for reaching conrmatory diagnosis of leprosy and its subtypes, differential diagnosis, prognosis of the disease and assessment or regression of the disease in patient under treatment and also for research, especially in early and borderline cases. The aim of this study was to correlate histopathological diagnosis of skin biopsies with clinical diagnosis of leprosy. This study was conducted to seek out and highlight the efcacy of the test and therefore its importance in current diagnostic scenario. MATERIALS AND METHODS: The retrospective study was carried out on the skin biopsies from untreated cases of leprosy seen in the Department of Dermatology and reported in the histopathology section of the Department of Pathology, School of Tropical Medicine, Calcutta between August 2016 to June 2019. HE sections of skin biopsies of all the cases of leprosy were examined for Epidermal atrophy, epithelioid granulomas, number & distribution of lymphocytes, histiocytes & foam cells; Inltration of nerves, blood vessels and adnexa; Grenz zone. Sections stained with ZN were examined for lepra bacilli in all cases. Histopathological ndings were graded into (TT), (BT), (BB), (BL) and (LL) according to Ridley and Jopling scale. Clinical diagnosis of the leprosy cases (as provided by department of Dermatology) using Ridley & Jopling scale was correlated with the results of histopathologic examinaton of their respective biopsies. RESULTS: Out of total cases in the OPD over Aug 2016 to June 2019,115 were sent for biopsy with conclusive clinical diagnosis of Leprosy out of which 45 cases came with the positive diagnosis of leprosy out of which TT(12) , BT(12), BB(3), BL(2),LL(8), Histoid(8). In 2016-17 the accuracy of clinichistopathological correlation was 35.4% ,41.3%in 2018 ,36.36% till mid 2019 . The discrepancy with the HPE refuting clinical diagnosis was 48.38% in 2017 ,58.62% in 2018 ,63.63% in mid 2019}. Histoid leprosy and ENL were 10 out of 31 cases in 2018-19 while 2cases were histopathologically diagnosed as leprosy despite having Sarcoidosis / Gr. Annulare clinically. Although the clinico- CONCLUSION: histopathological agreement in this study leaves much to be desired for prompt diagnosis, the disparity in correlation does decrease the chances of false positives and helps in better nalising the diagnosis for better treatment, Prognosis, follow-up and monitoring of the diseases are also aided by correct histopathological diagnosis especially in case of early and borderline cases of leprosy

An unusual ocular presentation of histoid leprosy

Leprosy is a chronic granulomatous infection caused by mycobacterium leprae, mainly affecting the skin and peripheral nerve. Histoid type of leprosy, which is considered as an extremely rare variant of lepromatous leprosy. We report a case of a 50/year old male presented to our institute with chief complain of conjunctival swelling in both eyes, encroaching over cornea and involving limbus and sclera, associated with painless blurring of vision. An incisional biopsy of the right eye was performed under local anesthesia. Histopathology of right eye biopsy revealed spindle shaped cells having bland looking nuclei and variable amount of cytoplasm which was suggestive of histoid leprosy. A dermatology consultation was sought and patient was diagnosed to have leprosy. Consequent to which he was started on MBALD (multibacillary anti leprosy drug), and showed improvement in patient`s visual acuity as well as regression of right eye swelling and disappearance of left eye swelling.