A Case Series of Histoid Leprosy with a Brief Comparison of the Clinical Features with that of Lepromatous Leprosy

Histoid leprosy (HL) is a rare highly bacilliferous variant of lepromatous leprosy (LL). We are describing here a case series of HL in a tertiary care centre along with a comparison of the clinical features with cases of LL encountered in the same centre. There were 6 cases of HL in our centre for the past 10 years accounting for 1.86% of the total number of leprosy cases. HL constituted 11.54% of the total LL cases. 4 cases were de novo HL and 2 cases due to relapse. Papules, plaques and nodules were the commonest primary skin lesions. The distribution was localised in HL, mainly confined to the upper and lower limbs, while in LL it was symmetrical and generalised and mainly localised to the trunk. Superciliary madarosis, ear lobe infiltration, glove and stocking type of anaesthesia were found in the majority of LL, while lacking in HL patients. Type 2 lepra reaction and Grade 2 disability was much more common in LL, than HL. A very important finding in this case series is that the mean BI and MI of HL was more than in LL. All the patients were given of MB-MDT for 12 months and in patients who had initial BI of 4+ or more were given 24 months treatment and there were no cases of relapse after release from treatment

Histoid Leprosy: Are We Still Harbouring Potential Community Menace? A Case Series from North-East India

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Histoid leprosy is considered an uncommon multibacillary form of leprosy characterized by presence of histoid lepromas which present as erythematous round or oval shaped glistening nodules. Most commonly this form of leprosy is seen in patients on irregular therapy with MDT. In this series we report a total of three cases with their clinical, histopathological and dermoscopic findings.

Histoid Leprosy Presenting with Borderline Tuberculoid Leprosy in Type 1 reaction: An Uncommon Shift of Spectrum

Histoid leprosy is an uncommon variant of leprosy with characteristic clinical, immunological and bacteriological features and is considered to be a polar variant of lepromatous leprosy. Coexistence of other immunologically diverse forms of leprosy in histoid end of spectrum is very rare. We report a rare case of histoid leprosy on multi-drug therapy for last 7 months shifting to borderline tuberculoid spectrum in type 1 reaction or Wade’s contamination, spectral shift

The Burden of Histoid Leprosy in Post Elimination Era

Histoid leprosy is a rare variant of lepromatous leprosy, may occur de novo or may occur in cases earlier treated with dapsone monotherapy. Demographic, clinico-histopathological and treatment details of biopsy proven cases of histoid leprosy, collected retrospectively from the leprosy clinic of tertiary care hospital of SMS Medical College, Jaipur. During the study period of 5 years (2011-2016), 28 (2.98 %), patients had histoid leprosy among total 937 patients of leprosy. Most were in 21 – 40 years of age group with M: F ratio 2.5: 1. Histoid lesions developed with primary diagnosis of lepromatous leprosy in (71.4%) and de novo in (28.6%). Predominant site of involvement was upper extremity (85.7%) and most common presentation was subcutaneous nodules, Nerve thickening seen in (85.7%), and ulnar nerve being most common. Neuritis and disabilities were present in 6 and 16 patients respectively. Type 2 reaction seen in17.9% (5/28) patients. Biopsy and slit skin smear of all cases were done. Most (25/28) cases responded well to standard one-year multibacillary drug therapy (MDT), it had to be extended in three cases up to 2 years. Histoid leprosy may occur de novo or may be due to inadequate therapy, resistant strains, earlier dapsone monotherapy. Although India as whole has achieved leprosy elimination in January 2006, however new cases continue to be reported. Occurrence of histoid leprosy specially with changed morphology of the lesions and poor histopathological correlation needs to be investigated as these cases may be important source of infection even in low endemic situations.

De-novo Histoid Leprosy: A Series of Four Cases

Histoid leprosy, an unusual variant of lepromatous leprosy, originally thought to manifest following dapsone monotherapy, is being increasingly reported ‘de-novo’. We hereby report four de-novo cases; one mimicking lupus pernio presenting with an uncommon lesion (plaque) at an extremely rare site (nose). Of the remaining three classical cases, one exhibited a not-so-frequent development of erythema nodosum leprosum (ENL) reaction that needed modified multidrug therapy for two years, other three responded well to standard multibacillary multidrug therapy which was also given for two years.

Corneal Leproma : A Rare Ocular Manifestation in Leprosy

A leproma is a discrete granulomatous nodule rich in lepra bacilli and is a rare yet characteristic finding seen in the lepromatous spectrum of Hansen’s disease. Majority of the ocular lepromas reported in the literature so far arise from uveal tissue and sclera with an incidence of 0.75 to 1%. Exclusive corneal leproma associated with multibacillary leprosy is an extremely rare finding. It is painless and silent nature in earlier stages because of that it may remain unattended for several years until significant visual loss, disease progression and transmission may continue to occur. We report a case having corneal leproma, the detection of which led to the uncovering of advanced cutaneous involvement. The patient had chosen not to disclose his skin involvement and disability possibly due to social stigma and partly due to ignorance. The presence of such untreated multi-bacillary forms in the community may present a significant hurdle for a country like ours, aiming to eliminate this chronic disease. Public awareness through health education coupled with early detection remains the cornerstone in tackling this multi-system disorder which has implications both from disability and transmission angles

de novo Histoid leprosy: an expatriate case recently diagnosed in Johannesburg

Abstract: Histoid leprosy (HL) is a rare variant of lepromatous leprosy with unique clinical, histopathological, and microbiological features. A 32-year-old man from Malawi who immigrated to Johannesburg 1-year-ago, presented with a 4-month history of flesh-colored nodules on the face and trunk and hyperpigmented plaques on the chest and limbs. Skin slit smears confirmed multibacillary leprosy, and skin punch biopsies showed proliferation of spindled cells containing a large number of acid-fast bacilli. The prevalence of de novo HL is increasing in the era of leprosy elimination. HL cases may act as reservoirs and negatively affect the global control of leprosy.

De novo histoid leprosy in an immunocompetent male: a rare case report from North east India

Histoid leprosy is a rare form of lepromatous (multibacillary) leprosy. This form of leprosy is fairly common in patients on dapsone monotherapy andirregular treatment. Sometimes it can arise de novo as well. Very few cases have been reported in immunocompetent individuals from India. I report a case of de novo histoid leprosy in a 22 year old male from north east India

De novo histoid leprosy in a Colombian patient with multiple skin nodules on the ears and extremities

Abstract Histoid leprosy is an uncommon form of lepromatous leprosy with distinct clinical, histopathological, immunological, and bacteriological features. This variant usually occurs in multibacillary patients who have irregular or inadequate treatment. Herein, we report a case of de novo histoid leprosy diagnosed in a patient from Cali, Colombia. In endemic areas, histoid leprosy should be in the differential diagnosis of any patient presenting with skin nodules. Early diagnosis and appropriate treatment are recommended for mitigating the impact of histoid leprosy cases, which are important reservoirs of Mycobacterium leprae.

Scenario of Histoid Hansen at a Tertiary Care Hospital in South India

Histoid Hansen's disease is a form of lepromatous leprosy with characteristic bacterial morphology and very high bacillary load. The occurrence of de novo' Histoid leprosy in patients without other features of leprosy has been reported. We present our observations on eleven cases of Histoid Hansen's disease who had attended our Outpatient Department. A detailed clinical history and clinical examination was done. Slit skin smear for Bacteriological Index and skin biopsy were performed in all. All eleven cases were males. Cutaneous and subcutaneous nodules were the commonest skin lesions found. Slit skin smear revealed abundant organisms. Histopathology was consistent with Histoid Hansen. Seven were de novo cases. During treatment, one patient developed type II reaction. All patients except one showed clinical clearance of lesions and fragmented bacilli after one year of MB-MDT. The treatment was extended in this single case who did not respond well. Awareness about the clinical features, characteristic histology and early diagnosis of Histoid Hansen is of utmost importance. It will be important to determine the bacteriological and morphological indices at the end of the treatment for all Histoid Hansen disease patients. Continuation of treatment may be decided based upon the bacterial and morphological indices.

A Rare Presentation of Histoid Leprosy: A Case Report

Histoid Leprosy is an expression of multibacillary leprosy, characterized by typical cutaneous and subcutaneous nodules and plaques present over an apparently normal skin and histopathologically the predominance of spindle-shaped cells or polygonal cells and unusually large number of acid fast bacilli. We report a case of histoid leprosy which was insidious in onset with multiple discrete lesions after release from treatment as a case of Hansen's disease seven years back. Initial FNAC report from a lesion revealed hemangioma which was unusual in presentation. He was later diagnosed clinically and histopathologically as a case of histoid leprosy.

Lepra histioide o de Wade: Presentación de un caso clínico / Wade histioid leprosy: A case report

La lepra histioide de Wade, es una forma clínico-histopatológica especial de lepra multibacilar, caracterizada por la presencia de tubérculos (lesiones papulosas o nodulares) correspondientes a lepromas formados por histiocitos de morfología fusiforme. La misma es una variante infrecuente de lepra lepromatosa, que se desarrolla generalmente como recaída, en pacientes que recibieron monoterapia con dapsona, aunque se reportó su presentación de novo. En el presente trabajo, se comunica el caso clínico de una paciente de sexo femenino de 45 años de edad, con diagnóstico tardío de lepra histioide. Además, se examinan las características principales de esta forma particular de expresión de la lepra, sus diferencias con la forma clásica de presentación, los diagnósticos diferenciales que deben considerarse y la importancia de tener a esta patología entre las sospechas diagnósticas, para comenzar el tratamiento adecuado y evitar su propagación.

Wade's hystioid leprosy is a special clinical-pathological form of multibacillary leprosy, characterized by papular and nodular lepromas that consist of spindle histiocytes. It is a variant of lepromatous leprosy. Most of the cases have been related to dapsone resistance in the context of longterm monotherapy. De novo cases, not associated with previous anti-leprosy treatment, have been less frequently reported. This article presents the case of 45 years old female, with late diagnosis of histoid leprosy. There will be explained the main features of this particular form of leprosy, its differences with the classic presentation, the differential diagnoses to be considered, and the importance of having this pathology among diagnostic suspicions to begin adecuate treatment.

Wade's histoid leprosy in a 14-year-old teenage boy

Abstract Wade's histoid leprosy (HL) is a rare variant of multibacillary leprosy, with characteristic clinical, immunologic, histopathologic, and bacteriologic features. It is associated with resistance to sulfa drugs or polychemotherapy and is rarely observed in patients who have not undergone prior treatment. Clinically, HL resembles keloid or dermatofibroma. Furthermore, HL is rare in children and is difficult to diagnose even by experts. This report describes a case of HL in a 14-year-old Brazilian boy, who presented with multiple nodular and tumor-like lesions, simulating keloids. He had not undergone prior treatment with anti-leprosy drugs, which accentuates the relevance of this case report.

Transepidermal elimination of Mycobacterium leprae in histoid leprosy: A case report suggesting possible participation of skin in leprosy transmission.

An Indian patient of histoid leprosy presenting de novo, having numerous solid staining bacilli inside the intact epidermis and eliminating bacilli from the intact and the eroded epidermis, is reported. The diagnosis, suggested by the clinical features, was confirmed histopathologically. This unusual report indicates possible participation of skin in leprosy transmission.

A Case of Histoid Leproma with Mycobacterium leprae Detected in the Peripheral Blood by polymerase Chain Reaction / 대한피부과학회지

Histoid leproma usually occur in pat.ients with lepromatous leproy who have had relapsed after being undcr treatment(usually sulfones) for a long time and who have shown variable improvement. A 56 year old female patient who had been suffering from lepromatous leprosy and had been treated which clapsone relatively regularly for approximately 28 years had a history of several shiny rice grain t.o peanut sized nodules on the face and right flank. Histopathologic examination of a specimen taken from a nodular lesian revealed a well circirmscrihed nodule composed mainly of spindle-shaped cells and epithe:ioi 1 cells on the upper and mid-levmis, and granuloma composed of epithelioid cells, multinucleated wait cells and foamy histiocytes on the lower dermis. In AFB stain, numerous acid-fast bacilli were scatt red dermis and epidermis, especially stratum corneum. This study opplied a polymease chain reaction(PCR) on sections of biopsy tissues and peripheral blood of pat.ient. Positive amplification of a 530 bp fragment was deteated not only in the lesion tissues but also in the per ipher al blood.