Authors: Andrea Aileen Marie V. Montelibano MD, Vilma O. Pelino, MD, FPDS


Introduction: Histoid leprosy (HL) in a rare variant of lepromatous leprosy (LL) which has distinct clinical, immunological, and bacteriologic findings. It presents as subcutaneous domeshaped, smooth, shiny papules or nodules arising from apparently normal skin. It was initially described in patients who were inadequately treated with dapsone monotherapy. However, de novo cases have been occasionally found.

Case Summary: A 39-year-old Filipino male presents with a 6-month history of multiple, firm, shiny, skin-colored to erythematous papules and nodules on the face, ears, trunk and extremities associated with occasional pruritus and pain. There was no impairment of temperature or touch sensations. There were no family members with the same complaints. Routine hematologic and urine investigations, liver and renal function tests, and chest Xray were normal. Slit skin smear revealed acid-fast bacilli of BI – 5+. Histopathology with hematoxylin and eosin stain revealed atrophic epidermis with a thin grenz zone and diffuse dermal infiltration of oval to elongated foamy histiocytes. Fite faraco stain for lepra bacilli showed BI – 6+. Thus, a diagnosis of histoid leprosy was made. The patient was started on multi-drug therapy with clinical improvement of after 1 month.

Conclusion: Histoid leprosy has a high bacillary index and may be a reservoir of infection. A high index of suspicion is necessary for early diagnosis and prompt treatment to prevent spread
of the disease.





leprosy, histoid leprosy

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