Clinicopathological correlation in leprosy

ABSTRACT

Background: Leprosy is a chronic granulomatous disorder that is caused by Mycobacterium leprae. It mostly affects skin and peripheral nerves. The disease has varied clinical and pathological manifestations depending on the immune response of the patient. Histopathology helps in confirming the diagnosis for clinically suspicious cases and helps in exact typing which, in turn, influences treatment plan. Objectives: The objectives of this study were to study the incidence of different subtypes of leprosy and to evaluate the correlation of clinical subtype with the histopathological subtype. Materials and Methods: This was a cross-sectional comparative study done over a period of 1.5 years from August 1, 2017, to January 31, 2019, of skin biopsies of patients newly diagnosed with leprosy using routine and special stains along with clinicopathological correlation. Results: A total of 41 patients were studied between 11 and 80 years of age with a mean age of 32.64 years. Male-to-female ratio was 1.561. The majority of patients (41.46%) belonged to the age group of 21–30 years. Histopathologically, tuberculoid leprosy (19.51%) was the most common type followed by lepromatous leprosy and erythema nodosum leprosum (17.07% each). Clinical and histopathological concordance was seen in 65.8% of cases. The concordance was highest (100%) in histoid leprosy, indeterminate leprosy, and Type 1 lepra reaction. The most common presenting lesion was a hypopigmented macule (41.46%) followed by nodules (29.26%). Fite-Faraco positivity was 41.46%. Conclusion: Cumulative clinical, histopathological, and bacteriological diagnoses help in accurate typing of leprosy, thus facilitating appropriate therapy to prevent complications.