Presentation Of Leprosy Research Articles

Borderline Lepromatous Leprosy Masquerading as Granuloma Annulare: A Case Report

Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium Leprae. Leprosy is a great imitator with its various atypical, unusual and varying clinical presentations which can be confused with many infectious and non-infectious diseases. Case Report: A 46-year-old female presented to the dermatology department with complaints of painful raised lesions over face, upper back, upper limbs, lower legs and feet for 12 months. Clinically suspected as a case of Granuloma annulare. Punch biopsy was taken which revealed epidermis with dermis showing nodules of histiocytes and lymphocytes with grenz zone at the dermoepidermal junction. Acid fast stain and Fite Faraco stain was performed which revealed the presence of leprae bacilli with bacteriological index of 4+. Conclusion: Detailed history taking and correlating clinical picture with morphology is required to diagnose atypical presentations of leprosy. Early diagnosis helps to provide appropriate treatment and thus prevent from devastating complications.

Ulcerative type 1 lepra reaction in borderline-tuberculoid leprosy

Introduction: leprosy is a chronic infectious disease caused by Mycobacterium leprae, characterized by a wide spectrum of clinical presentations. In India, borderline-tuberculoid leprosy is the most common form encountered in clinical practice. Type 1 lepra reaction in borderline- uberculoid leprosy usually presents as the development of erythema and/or edema in pre-existing skin lesions. Ulceration of skin lesions in type 1 lepra reaction is uncommon and occurs in severe reactions. Objective: to report an unusual presentation of borderline-tuberculoid leprosy with ulcerative type 1 lepra reaction in an immunocompetent patient. Case description: we present the case of a 65-yearold man with chief complaints of ulcerated plaque over his left thigh. He also had other skin lesions suggestive of borderline-tuberculoid leprosy over his trunk and limbs, as well asenlarged, mildly tender left ulnar and lateral popliteal nerves. A slit skin smear was negative, while a skin biopsy supported the diagnosis of borderline-tuberculoid leprosy. The patient responded to multibacillary multidrug therapy according recommended by World Health Organization and tapering doses of prednisolone, with complete healing of the ulceration at six weeks follow-up. Discussion: type 1 lepra reaction associated with borderline-tuberculoid leprosy usually presents with increased erythema and edema in pre-existing skin lesions. Ulceration in such skin lesions is not commonly seen except in cases with severe type 1 leprosy reactions. Administration of oral corticosteroids along with multibacillary multidrug therapy is the key to managing ulcerative type 1 lepra reaction. The ulceration heals rapidly with tapering doses of oral corticosteroids, limiting the duration of morbidity. Final consideration: the case emphasizes the need for dermatologists and leprologists to be aware of atypical presentations of leprosy reactions, ensuring timely diagnosis and effective management to achieve optimal patient outcomes.

Unveiling the nerve bumps in Hansen’s arm and forearm

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Intraneural abscess is the rare presentation of leprosy, which poses a diagnostic challenge to the clinician as well as the radiologist. Early identification, diagnosis, and treatment are imperative to reduce the disability. We wish to highlight the features of this rare entity in a 14-year-old male child who presented with painless swelling in arm and forearm.

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.

From periphery to center, untold story of pure neuritic leprosy: an electrophysiological study.

Pure neuritic leprosy (PNL) is uncommon form of leprosy involving peripheral nerves. Some isolated case reports have shown imaging changes in the central nervous system (CNS) and also impairment in visual evoked potential (VEP), somatosensory evoked potential (SSEP) and brain stem auditory-evoked potentials (BAEPs) parameters in PNL, but there is lack of large study. This prospective observational study evaluates impairment in these central conduction studies among PNL patients. We screened patients with leprosy presenting with features of neuropathy and/or thickened nerves. Patients with bacilli-positive nerve biopsies were included in the study and subjected to routine tests along with nerve conduction study (NCS), VEP, tibial SSEP and BAEPs. Parameters of these studies were analyzed based on data from previous studies. Of 76 patients screened for PNL 49 had positive findings in biopsy. Most of patients were male and mean age group was 46.35 ± 15.35years. Mononeuritis multiplex was most common NCS pattern in 46.93% (23/49) patients. We found abnormal VEP in 13 out of 35 patients (37.14%). Similarly abnormal SSEP and BAEPs among 42.85% and 40% patients respectively. This study shows that in PNL significant number of patients have subclinical CNS involvement. Exact pathophysiology of CNS involvement is not known till now but study of VEP, SSEP and BAEPs parameter may help in early diagnosis of PNL.

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.

Leprosy in Children with a Focus on the Asian Region: A Narrative Review

Abstract Children are often more susceptible to contracting Mycobacterium leprae infection because of their immature immunity as well as their exposure to intrafamily interactions. The percentage of children among newly identified leprosy cases serves as a robust indicator of the ongoing transmission of the disease. Globally, the number of new cases fell by 19.3% between 2013 and 2022. A reduction of over 50% in the incidence of leprosy among children was seen, with rates declining from 10.4 cases per million children in 2013 to 5.1 per million in 2022. Children may exhibit atypical clinical symptoms, and the clinical presentation of leprosy in children can often be misdiagnosed as differential diagnoses such as pityriasis alba, nevus depigmentosus, pityriasis versicolor, among others, contributing to diagnostic difficulties. The cultural stigma surrounding leprosy may also discourage parents from seeking medical help promptly, prolonging the time to diagnosis. Furthermore, health-care systems in some regions may lack adequate training or resources for diagnosing pediatric leprosy. These challenges underscore the importance of increased awareness, early detection, and improved health-care infrastructure to effectively diagnose and treat leprosy in children. Stakeholders must give top priority in policy making and interventions to lower the prevalence of leprosy and its consequences in children and adolescents. The present article is an attempt to review the epidemiological, clinical, and therapeutic dimensions of childhood leprosy cases in Asia.

A Case Report of Leprosy Presenting as Multiple Mononeuropathy with Hypoesthesia

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It can lead to damage of the nerve. Although the incidence of leprosy is very low in South Korea, a large number of people are immigrating to South Korea from countries with a high prevalence of leprosy. We report a case of leprosy confirmed by nerve biopsy. The patient was from Nepal who presented with progressive and asymmetric sensory loss. Leprosy can be considered as a differential diagnosis in patients with progressive and asymmetric sensory loss, especially when patients are from leprosy endemic countries.

Hansen’s Disease with Pure Nerve Involvement and Perineural Abscess Mistaken for Peripheral Nerve Sheath Tumour

Nerve abscess is an infrequently reported complication of leprosy. It is also an uncommon first manifestation of leprosy. In this case, due to the absence of classic signs and symptoms, such as skin lesions, hypoesthesia, and loss of sensation, the swelling was clinically diagnosed as a peripheral nerve sheath tumour on initial presentation. The authors have described an unusual presentation of pure neuritic leprosy that showcased nerve abscess. Clinical presentation was swelling over the medial aspect of the right arm and ulnar aspect of the right forearm, and clawing of the fourth and fifth digits of the right hand, with no signs of inflammation present on the skin surrounding the swelling. Hansen’s disease with pure nerve involvement could not be considered as a differential diagnosis solely based on clinical examination, therefore posing a diagnostic challenge. On ultrasonography, the right ulnar nerve showed diffuse intermittent thickening and a heterogeneously hypoechoic fusiform area with internal echoes at the site of swelling indicating a nerve abscess. These led the authors to the diagnosis of leprosy with perineuronal abscess. Histopathology confirmed the diagnosis by revealing granulomas and acid-fast Hansen’s bacilli. The patient showed dramatic response to surgery, multidrug therapy, and systemic corticosteroids.

Comprehensive Analysis of the Clinical and Pathological Presentation of Nodular Lepromatous Leprosy: A Prospective and Multidisciplinary Evaluation

Nodular lepromatous leprosy, an atypical and advanced manifestation of lepromatous leprosy, constitutes a significant clinical and diagnostic challenge in the dermatologic disease landscape. In the present study, a comprehensive and multidimensional inquiry of this leprosy variant is undertaken to provide an enriched understanding of its clinical phenotype and underlying pathologic profile. This article is based on a prospective investigation involving a series of patients with nodular lepromatous leprosy, in which detailed clinical, histopathological and immunohistochemical analyses were performed. Through the integration of clinical findings with microscopic evaluations, the distinctive features of this nodular form are delineated, highlighting its diversified clinical presentation, which may include cutaneous nodules, peripheral nerve involvement and advanced systemic dissemination. Histopathological analysis highlights the diffuse infiltration of infected Schwann cells in the dermal nodules, as well as Langerhans cell hyperplasia and intense inflammatory response. In addition, immunohistochemical implications are explored, revealing increased expression of inflammatory markers and the involvement of immunomodulatory cells in the pathogenesis of the disease. Overall, this article seeks to fill the gap in the medical literature regarding nodular lepromatous leprosy by providing a comprehensive and up-to-date assessment of its clinical presentation and pathologic basis. The information derived from this study may not only enrich the current understanding of lepromatous leprosy as a whole, but also guide future research toward more precise and personalized therapeutic approaches for this particular clinical variant.

Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study.

This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.

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.

Observational Study of Leprosy Presenting with Solitary Skin Lesion from a Tertiary Care Hospital in South India

Background: Leprosy presents with varied clinical morphology, and most often the morphological pattern and distribution of lesions denote a particular spectrum of leprosy; however, it may not be correct in all the cases which can lead to under treatment and dissemination of infection, particularly, in multibacillary leprosy presenting with single skin lesion. Objective: The objective of the study was to describe cases of leprosy presenting with solitary skin lesion and to establish the spectrum by slit-skin smear (SSS) and histopathological examination of skin biopsy. Materials and Methods: A prospective study involving thirty cases of leprosy presenting with single skin lesion to the department of dermatology of a tertiary care hospital spread over 2 years. Examination of skin lesion and nerves was carried out, and details were recorded. Routine hematological and biochemical investigations were done. SSS from the lesion, both ear lobes, right elbow, left middle finger, and right middle toe and lesional biopsy was done. Bacteriological index and morphological index were calculated in all cases, and the diagnosis was correlated by histopathology. Results: Of the thirty cases studied, twenty were males (66.7%) and ten (33.3%) were females with male-to-female ratio of 2:1. The most common age group afflicted was 21–40 years (70%). Hypopigmented patch was the most common presentation 19 (63.3%) in our study. The most common site of patch was forearm in 9 (30%). Of the thirty cases, 20 (66.7%) were diagnosed as borderline tuberculoid, 9 (30%) as tuberculoid tuberculosis, and 1 (3.3%) as indeterminate leprosy. Ulnar nerve was the most common nerve involved (80%). Ten patients (33.3%) were positive and twenty (66.7%) were negative for acid-fast bacilli on SSS examination. Out of the thirty clinically diagnosed leprosy cases, 19 (63.3%) showed positive histopathological correlation. Conclusions: The presentation of borderline lepromatous leprosy and lepromatous leprosy as single skin lesion reinforces the fact that certain aspects of the host cell-mediated response and pathophysiology of this disease are still not fully understood. It illustrates the importance of SSS and biopsy in these cases as such cases are undertreated.

Anetoderma - A Hidden Presentation of Lepromatous Leprosy

Anetodermas is a rare disorder of connective tissue associated with a circumscribed area of slack skin associated with focal loss of elastin. This correlates with the clinical observation of atrophy and “buttonhole” sign or herniation phenomenon. Secondary anetoderma has multiple causes, which should be looked for, out of which lepromatous leprosy is rare. It is important to identify infective conditions like leprosy not only for the individual but also epidemiological control as well. We report a case of Lepromatous leprosy presenting as anetoderma.

Unusual clinical presentations in leprosy: a case series and review.

Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease.

Pseudoainhum and lepromatous leprosy: a very rare association in the modern world

Introduction: Pseudoainhum (dactylolysis spontanea) is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation. Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions. Case presentation: The current report describes a very rare association of pseudoainhum with leprosy. The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum. Discussion: Conclusion: This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits, especially in leprosy.

Diagnosing and treating leprosy in a non-endemic setting in a national centre, London, United Kingdom 1995-2018.

Leprosy is rare in the United Kingdom (UK), but migration from endemic countries results in new cases being diagnosed each year. We documented the clinical presentation of leprosy in a non-endemic setting. Demographic and clinical data on all new cases of leprosy managed in the Leprosy Clinic at the Hospital for Tropical Diseases, London between 1995 and 2018 were analysed. 157 individuals with a median age of 34 (range 13-85) years were included. 67.5% were male. Patients came from 34 different countries and most contracted leprosy before migrating to the UK. Eighty-two (51.6%) acquired the infection in India, Sri Lanka, Bangladesh, Nepal and Pakistan. 30 patients (19.1%) acquired leprosy in Africa, including 11 from Nigeria. Seven patients were born in Europe; three acquired their leprosy infection in Africa, three in South East Asia, and one in Europe. The mean interval between arrival in the UK and symptom onset was 5.87 years (SD 10.33), the longest time to diagnosis was 20 years. Borderline tuberculoid leprosy (n = 71, 42.0%), and lepromatous leprosy (n =, 53 33.1%) were the commonest Ridley Jopling types. Dermatologists were the specialists diagnosing leprosy most often. Individuals were treated with World Health Organization recommended drug regimens (rifampicin, dapsone and clofazimine). Leprosy is not a disease of travellers but develops after residence in an leprosy endemic area. The number of individuals from a leprosy endemic country reflect both the leprosy prevalence and the migration rates to the United Kingdom. There are challenges in diagnosing leprosy in non-endemic areas and clinicians need to recognise the symptoms and signs of leprosy.

Swollen hands and feet syndrome: An uncommon presentation of a common disease.

Leprosy is an infectious disease caused by M. leprae with predominant skin and neurological involvement. Although musculoskeletal involvement can occur in leprosy during the disease course, the first presentation of leprosy with musculoskeletal manifestation is relatively rare. Here we present a case that presented musculoskeletal manifestation as an initial feature.

Central nervous system, spinal root ganglion and brachial plexus involvement in leprosy: A prospective study.

BackgroundLeprosy is primarily a disease of peripheral nerves. Some isolated case reports and case series have communicated imaging changes in the central nervous system (CNS) and brachial plexus in patients with leprosy.ObjectivesTo study the neuroimaging abnormalities in patients with lepra bacilli-positive neuropathy in the context of CNS, spinal root ganglion, and brachial plexus.DesignProspective observational studyMethodsWe screened newly-diagnosed patients with multibacillary leprosy presenting with neuropathy. Patients with bacilli-positive sural nerve biopsies were included in the study and subjected to magnetic resonance imaging (MRI) of the brain and spinal cord.ResultsA total of 54 patients with bacteriologically confirmed multibacillary leprosy were screened; Mycobacterium leprae was demonstrated in the sural nerve biopsies of 29 patients. Five patients (5/29; 17.24%) had MRI abnormalities in CNS, spinal root ganglion, and/or brachial plexus. Three patients had MRI changes suggestive of either myelitis or ganglionitis. One patient had T2/FLAIR hyperintensity in the middle cerebellar peduncle while 1 had T2/FLAIR hyperintensity in the brachial plexus.ConclusionCNS, spinal root ganglion, and brachial plexus are involved in patients with leprous neuropathy. Immunological reaction against M leprae antigen might be a plausible pathogenetic mechanism for brachial plexus and CNS imaging abnormalities.

Association of CD209 (DC-SIGN) rs735240 SNV with paucibacillary leprosy in the Brazilian population and its functional effects.

BACKGROUND Leprosy, caused by Mycobacterium leprae, is a public health problem in Brazil that affects peripheral nerves, resulting in physical disabilities. During host-pathogen interactions, the immune response determines leprosy outcomes from a localised (paucibacillary) form to a disseminated (multibacillary) form. The recognition of M. leprae involves the DC-SIGN receptor, which is present on the dendritic cells (DCs) and participates in immune activation.OBJECTIVES To evaluate the association of polymorphisms in the promoter region of the gene encoding DC-SIGN (CD209) and the clinical form of leprosy, and to investigate its functional effects.METHODS The study population included 406 leprosy patients from an endemic area in Brazil [310 multibacillary (MB); 96 paucibacillary (PB)]. A functional evaluation based on the effects of the single nucleotide variant (SNV) associated with PB leprosy on the specific immune response was also performed.RESULTS The GA genotype and the presence of the A allele of rs735240 (-939G>A) were associated with PB leprosy [OR: 2.09 (1.18-3.69) and 1.84 (1.07-3.14), respectively]. Carriers of the A allele showed reduced expression of CD209 and TGF-β1 in leprosy lesions in comparison with individuals with GG genotype, in addition to a higher response to the Mitsuda test.CONCLUSION These data suggest that rs735240 influences the immune response against M. leprae and clinical presentation of leprosy.