Single lesion Lepromatous Leprosy in a teenager: An unexpected scenario

Introduction@#Hansen’s disease (HD) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system caused by Mycobacterium leprae. The incubation period varies from months to more than 30 years. The tuberculoid form of HD usually presents with a single hypoesthetic patch and skin biopsy shows epithelioid granulomas with absence of bacilli on Fite-Faraco stain. In contradistinction, lepromatous leprosy usually presents with numerous papules, plaques and nodules with induration of the ears and nose. Biopsy shows foamy granulomas with presence of acid-fast bacilli on Fite-Faraco stain.@*Case summary@#We present a case of a 13-year old female who presented with a 3-year history of a single hypoesthetic patch on the left knee. The initial clinical diagnosis was tuberculoid leprosy. However, histopathology revealed a Grenz zone, and a nodular granulomatous infiltrate consisting of epitheloid and foamy histiocytes with scattered lymphocytes. Fite-Faraco stain showed a bacillary index (BI) of 3+. Slit-skin smear revealed a BI of 4+. She was then started on multidrug therapy.@*Conclusion@#This case highlights the importance of slit-skin smear and biopsy as routine procedures in all new cases of suspected HD. These procedures will help differentiate multibacillary from paucibacillary forms of the disease which will influence decisions for treatment and prognostication. This case emphasizes that lepromatous leprosy may present with single lesions and may be misdiagnosed as paucibacillary leprosy if skin-slit smear and biopsy have not been done. This case further suggests that there are factors yet undetermined which play significant roles in determining the host response to M. leprae which are believed to influence morphology, configuration, number and distribution of skin lesions.

Prevalences of Actinic Skin Lesions and Comparison of Single and Multiple Lesions in Patients with Actinic Keratosis: A Retrospective Study of 61 Patients / 대한피부과학회지

BACKGROUND: Photoaged skin is characterized by actinic skin lesions such as wrinkling, elastosis, and premalignant and malignant lesions. Actinic keratosis (AK) is one of the most common precancerous lesions, and multiple actinic keratosis lesions are one of the risk factors for skin cancer. Few studies have investigated the prevalences of actinic skin lesions and compared the characteristics of the lesions and the patients with sinle and multiple AK lesions. OBJECTIVE: The aim of this study was to evaluate the prevalences of actinic skin lesions and to compare characteristics between single and multiple lesions in Korean patients with AK. METHODS: We retrospectively reviewed the medical records and biopsy specimens of 61 patients. RESULTS: Frequencies of deep wrinkle, solar elastosis, cutis rhomboidalis nuchae, and senile purpura were higher in the multiple lesions group. The ratio of males to females was 1:3.43 and the mean age was 79 years in the multiple lesions group, both of which were higher than those in the single lesion group (1:1.14, 72 years). The mean duration was longer in the multiple lesions group. Sun protective behavior was more frequent in the single lesion group, and the occupation of farmer was more common in the multiple lesions group. There was no statistically significant clinicopathological difference between the two groups. CONCLUSION: This study may improve our understanding of the characteristics of actinic keratosis with both single and multiple lesions.

A Case of Global Aphasia Without Other Focal Neurologic Lateralizing Signs

Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.