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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 17  |  Issue : 3  |  Page : 212-214

Histoid leprosy in a 12-year-old child: A rare presentation


Department of Dermatology, Venereology and Leprology, All Institute of Medical Sciences, Raipur, Chhattisgarh, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Sandeep Anilrao Kulkarni
Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Raipur - 492 010, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.179483

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  Abstract 

Histoid leprosy is a clinical variant of nodular form of lepromatous leprosy. De novo histoid leprosy in children is a rare clinical presentation. We hereby report a case of a 12-year-old child presenting with lesions of histoid leprosy.

Keywords: Histoid, lepromatous, transepidermal


How to cite this article:
Kulkarni SA, Chhabra N, Prabha N. Histoid leprosy in a 12-year-old child: A rare presentation. Indian J Paediatr Dermatol 2016;17:212-4

How to cite this URL:
Kulkarni SA, Chhabra N, Prabha N. Histoid leprosy in a 12-year-old child: A rare presentation. Indian J Paediatr Dermatol [serial online] 2016 [cited 2019 Oct 19];17:212-4. Available from: http://www.ijpd.in/text.asp?2016/17/3/212/179483


  Introduction Top


Histoid leprosy is a rare form of multibacillary (MB) leprosy with unique clinical and histopathological features. However, the condition is not uncommon in India, and often it is poorly addressed. It is characterized by firm, dome-shaped, smooth, globular, painless, cutaneous, or subcutaneous nodules that appear on normal-looking skin. It was first described by Wade in 1963.[1]


  Case Report Top


A 12-year-old male, resident of Uttar Pradesh, presented to our department complaining of insidious onset, slowly progressive, multiple, asymptomatic, skin colored, semi-translucent, raised lesions involving face, both upper and lower extremities, and back since last 1 year. Patient complained of slight tingling sensation of lower extremities. There were no complaints of any sensory loss or motor weakness.

Past history and family history did not reveal any chronic relapsing course and familial involvement. Patient had not taken any treatment for the condition.

Clinical examination revealed multiple, nontender, soft to firm, semi-translucent, shiny, succulent, papulonodules involving face [Figure 1], both upper arms [Figure 2], back, and legs including soles. Interlesional skin was normal. Bilateral ulnar nerves were thickened and nontender. Sensory and motor examination were within normal limits. Systemic and ocular examination was normal.
Figure 1: Multiple, shiny, discreet, semi-translucent, papulonodules involving face (forehead, cheeks, and chin)

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Figure 2: Sections of epidermis and dermis with subepidermal infiltration free (grenz zone) along with large no of fusiform-shaped cells with elongated nuclei arranged in whorled pattern (×40)

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Mucosal examination and genital examination were within normal limits. Slit skin smear from the lesions was positive for acid-fast Bacilli with bacteriological index of 4+. Histopathological examination revealed spindle cell granulomas arranged in a whorled pattern in the upper dermis. The cells were fusiform in shape with moderate, eosinophilic cytoplasm, and elongated nuclei [Figure 3].
Figure 3: Fite faraco stained section showing large no of slender acid-fast Bacilli within spindle-shaped cells

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Fite faraco staining showed large no of Bacilli appearing as slender rods, arranged parallel long axis of cells, longer than usual size.

Based on clinicohistological presentation, a diagnosis of histoid leprosy was made. The child has been prescribed multibacillary multidrug therapy (MB[MDT]) for 2 years.


  Discussion Top


Histoid has been classified as a clinical subtype of lepromatous leprosy.[1] Sehgal and Srivastava [2] labeled it as a distinct clinicohistological entity in 1985. It clinically presents as multiple skin-colored soft to firm papulonodules, subcutaneous nodules, or fixed plaques. Lesions resembling neurofibromatosis [3] and molluscoid lesions of histoid leprosy [4],[5] are also known.

Common sites of involvement include face, abdomen, back, buttocks, and extremities.[2] The underlying as well as interlesional skin is usually normal. Histopathologically, it shows a well-configured palisade of spindle-shaped histiocytes having abundant cytoplasm with an array of long, slender, viable Bacilli arranged in parallel bundles along the long axis of cells. This pattern of arrangement of spindle cells mimics histological morphology of histiocytoma; from where the term “histoid” is derived.[6] The granuloma in histoid leprosy, thus, unlike lepromatous leprosy; mimics a neoplastic process rather than conventional inflammatory lepromatous process.

Histoid leprosy was considered an outcome of resistance to dapsone monotherapy/MDT; however, de novo[3],[7] histoid leprosy cases have also been reported.

According to NLEP progress report 2011–2012, a total of 12,305 new child cases were recorded; which gives the Child Case rate of 1.0/100,000 population. In nine states/Union Territories, more than 10% of new cases detected were children.[8]

Leprosy in children presents predominantly as Paucibacillary disease. De Novo Histoid leprosy in children is considered extremely rare [5],[9] with average age range affected being 21–40 years. With “transepidermal elimination”[5],[10] being attributed as one of the modes of transmission of Mycobacterium leprae; such cases assume epidemiological significance as they serve as reservoir cases in community with high bacillary load with potential of perpetuating infection in endemic areas.


  Conclusion Top


Deceptive presentations of histoid leprosy in children (unconventional age groups) can pose diagnostic dilemmas. High index of clinical suspicion is warranted for diagnostic considerations. The case is being reported to create awareness and to emphasize the rarity or atypical clinical presentation of histoid leprosy.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wade HW. The histoid variety of lepromatous leprosy. Int J Lepr 1963;31:129-42.  Back to cited text no. 1
    
2.
Sehgal VN, Srivastava G. Histoid leprosy A review. Int J Dermatol 1985;24:286-92.  Back to cited text no. 2
    
3.
Murthy SV, Rao SM, Thejaswini, Mannan K. De-novo histoid leprosy. J Lab Physicians 2011;3:110-2.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Ghorpade A. Molluscoid skin lesions in histoid leprosy with pseudo-isomorphic Koebner phenomenon. Int J Dermatol 2008;47:1278-80.  Back to cited text no. 4
    
5.
Chander R, Jabeen M, Malik M. Molluscum contagiosum-like lesions in histoid leprosy in a 10-year-old Indian boy. Pediatr Dermatol 2013;30:e261-2.  Back to cited text no. 5
    
6.
Poriccha D, Natarajan M. Pathological aspects. In: Kar HK, Kumar B, editors. IAL Textbook of Leprosy. 1st ed. New Delhi: Jaypee Brothers; 2010. p. 105-6.  Back to cited text no. 6
    
7.
Vora RV, Pilani AP, Mehta MJ, Chaudhari A, Patel N. De-novo histoid hansen cases. J Glob Infect Dis 2014;6:19-22.  Back to cited text no. 7
    
8.
NLEP. Progress Report for the Year 2011-12 Ending on 31st March 2012, Central Leprosy Division, Directorate General of Health Services, New Delhi; 2012.  Back to cited text no. 8
    
9.
Sehgal VN, Chaudhry AK. Leprosy in children: A prospective study. Int J Dermatol 1993;32:194-7.  Back to cited text no. 9
    
10.
Ghorpade AK. Transepidermal elimination of Mycobacterium leprae in histoid leprosy: A case report suggesting possible participation of skin in leprosy transmission. Indian J Dermatol Venereol Leprol 2011;77:59-61.  Back to cited text no. 10
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Introduction
Case Report
Discussion
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