A rare case of mid-borderline leprosy

Abstract

Leprosy is an infectious disease, which is caused by Mycobacterium leprae. Majority of the times, clinical judgment is enough for diagnosis. However, in some, histopathology can be essential. A 33-year-old male presented with asymptomatic red raised lesions over the face, upper limbs and lower limbs for the past 3 months. On examination, multiple erythematous, annular, asymmetrically distributed, infiltrated plaques with sharply punched out inner margins and sloping outer margins with clinically normal skin in the center, were found over the face, upper and lower limbs. Altered tactile sensations were noted over the lesions on the lower limbs. Bilateral ulnar and lateral popliteal nerves were thickened but not- tender. Slit skin smear showed M.leprae. Based on the characteristic morphology of the lesions and other clinical features, a diagnosis of mid- borderline leprosy was made. Histopathology showed normal epidermis with underlying dermis showing multiple well-defined granulomas composed of epithelioid cells and Langhans type of giant cells with scanty lymphocytic infiltration. The case is being presented in the light of clinical-histological disparity. This highlights the importance of histopathological examination for exact subtyping of leprosy to facilitate the institution of the accurate mode of therapy with stress on the importance of newer MDT in such cases to prevent drug- resistance, relapse and recurrence.