ABSTRACT
Cutaneous tuberculosis classically presents as Lupus vulgaris, scrofuloderma, tuberculosis verrucose cutis and tubercular abscess. Hypersensitivity reaction to the bacilli leads to Lichen scrofulosorum and papulonecrotic tuberculids. At the same time, it can have myriad of clinical presentations, many of which are still undescribed. It is important to regularly update ourselves with these unusual manifestations so as to ensure early treatment and reduction of overall morbidity. In this case series tuberculosis manifesting as rapidly progressing diffuse facial granulomas, sporotrichoid tuberculosis, tuberculosis mimicking squamous cell carcinoma, scrofuloderma as tubercular ulcer, lupus vulgaris with nasal septal perforation, lupus vulgaris resembling furuncle, psoriasis, dermatitis and BT Hansen are described in immunocompetent individuals. These cases highlight the importance of recognition of atypical forms of cutaneous tuberculosis to minimize scarring and dissemination of bacilli.
Subject(s)
Carcinoma, Squamous Cell , Lupus Vulgaris , Tuberculosis, Cutaneous , Humans , Lupus Vulgaris/diagnosis , Lupus Vulgaris/drug therapy , Tuberculosis, Cutaneous/diagnosis , Tuberculosis, Cutaneous/drug therapySubject(s)
Eyelashes/pathology , Leprosy, Lepromatous/diagnosis , Nose/pathology , Rhinoscleroma/diagnosis , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Biopsy/methods , Drug Therapy, Combination , Erythema/diagnosis , Erythema/pathology , Female , Humans , Klebsiella pneumoniae/isolation & purification , Leprostatic Agents/therapeutic use , Leprosy, Lepromatous/complications , Leprosy, Lepromatous/microbiology , Leprosy, Lepromatous/pathology , Lost to Follow-Up , Middle Aged , Mycobacterium leprae/isolation & purification , Rhinoscleroma/etiology , Rhinoscleroma/microbiology , Rhinoscleroma/pathologyABSTRACT
BACKGROUND: Histoid leprosy is a subtype of leprosy with distinct clinical presentation and histologic features. It accounts for <4% of leprosy cases. The exact location of histoid leprosy along the immune spectrum and its relation to other subtypes is unclear. AIM: To evaluate the local immune phenomenon which define histoid leprosy. DESIGN: Parallel skin biopsies from histoid lesions and from unremarkable skin in patients with histoid leprosy were evaluated and the histologic findings compared. METHODS: Formalin fixed, paraffin embedded tissue sections from lesional and non-lesional biopsies were assessed for changes in epidermis and dermis; type and extent of infiltrate, presence or absence of pseudocapsule and associated reactions. Bacillary index was evaluated using Wade Fite stain for lepra bacilli. RESULTS: Amongst 208 leprosy cases, six cases of histoid leprosy were identified (2.88%). The cases showed presence of nodules, patches and plaques overlying clinically unremarkable skin. Fourteen skin biopsies were evaluated of which the lesional biopsies showed equal proportion of fusocellular, fusocellular epithelioid and fusocellular-vacuolated histology. A greater circumscription was noted in lesional biopsies; however the cellular content of the infiltrate was similar in lesional and non-lesional biopsies. A case of erythema nodosum leprosum in histoid leprosy was also seen. CONCLUSIONS: Ours is the first study comparing normal and lesional skin in histoid leprosy. Though the histoid lesions appear to have a derivation from lepromatous leprosy, the local histologic and clinical alterations may be a result of heightened local immunity or reactive local modifying factors.
