Histoid leprosy: a rare exuberant case

Andrade, Pedro Jose Secchin de; Messias, Sulamita dos Santos Nascimento Dutra; Ferreira, Paola Cristina Brandão Oliveira; Sales, Anna Maria; Machado, Alice de Miranda; Nery, José Augusto da Costa

doi:10.1590/abd1806-4841.20154049

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

¹Wade HW. Histoid variety of lepromatous leprosy. Int J Lepr. 1963;31:129-42.
²Rodriguez JN. The histoid leproma, its characteristics and significance. Int J Lepr Other Mycobact Dis. 1969;37:1-21.
³Sehgal VN, Srivastava G. Status of histoid leprosy - a clinical, bacteriological, histopathological and immunological appraisal. J Dermatol. 1987;14:38-42.
⁴Kaur I, Dogra S, De D, Saikia UN. Histoid leprosy: a retrospective study of 40 cases from India. Br J Dermatol. 2009;160:305-10.
⁵Nair SP, Moorthy KP, Suprakasan S, Jayapalan S, Mini G. Histoid leprosy - unusual presentation. Int J Dermatol. 2006;45:433-4.
⁶Sehgal, VN, Govind S, Navjeevan S. Histoid leprosy: histopathological connotations' relevance in contemporary context. Am J Dermatopathol. 2009;31:268-71.
⁷Mansfield RE. Histoid leprosy. Arch Pathol. 1969;87:580-5.
⁸Sehgal 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.
⁹Lastória JC, Carlos AM, Putinatti MSMA. Hanseníase: realidade no seu diagnóstico clínico. Hansen Int. 2003;28:53-8.

Publication Dates

Publication in this collection
Sep-Oct 2015

History

Received
17 Sept 2014
Accepted
12 Jan 2015

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.

[1] ¹Wade HW. Histoid variety of lepromatous leprosy. Int J Lepr. 1963;31:129-42.

[2] ²Rodriguez JN. The histoid leproma, its characteristics and significance. Int J Lepr Other Mycobact Dis. 1969;37:1-21.

[3] ³Sehgal VN, Srivastava G. Status of histoid leprosy - a clinical, bacteriological, histopathological and immunological appraisal. J Dermatol. 1987;14:38-42.

[4] ⁴Kaur I, Dogra S, De D, Saikia UN. Histoid leprosy: a retrospective study of 40 cases from India. Br J Dermatol. 2009;160:305-10.

[5] ⁵Nair SP, Moorthy KP, Suprakasan S, Jayapalan S, Mini G. Histoid leprosy - unusual presentation. Int J Dermatol. 2006;45:433-4.

[6] ⁶Sehgal, VN, Govind S, Navjeevan S. Histoid leprosy: histopathological connotations' relevance in contemporary context. Am J Dermatopathol. 2009;31:268-71.

[7] ⁷Mansfield RE. Histoid leprosy. Arch Pathol. 1969;87:580-5.

[8] ⁸Sehgal 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.

[9] ⁹Lastória JC, Carlos AM, Putinatti MSMA. Hanseníase: realidade no seu diagnóstico clínico. Hansen Int. 2003;28:53-8.

Histoid leprosy: a rare exuberant case*

Abstract

REFERENCES

Publication Dates

History

Histoid leprosy: a rare exuberant case^*