College of Medicine and JNM Hospital, Kalyani, India
Avijit Mondal
Keywords
Peripheral nerve thickeningAcid fast bacilliLeprosyHansen’s diseaseMycobacterium leprae
A 19-year-old male presented to the dermatology OPD with hypopigmented skin lesions on trunk and limbs for 6 months, along with complaints of decreased sensation over both lower legs. Cutaneous examination showed bilaterally distributed multiple hypopigmented and slightly erythematous ill-defined macules, papules and plaques on upper limb and abdomen. There was multiple, soft to firm, dusky erythematous plaques and nodules on the face with similar lesions involving ear (Fig. 19.1). Similar hypopigmented macules, dull red nodules and plaques were seen on back (Fig. 19.2). Bilateral non-tender thickening of ulnar and common peroneal nerves were noted. Loss of sensation of temperature, touch, and diminished pain perception were elicited in both the lower legs along with dryness and loss of hair. There is no history of similar lesions in family members. There was no history of cough or difficulty in breathing. No generalized lymphadenopathy and no organomegaly were found.
Figure 19.1
Multiple hypopigmented slightly erythematous macules and few papules and plaques on abdomen and right upper limb. Note plaques and nodules on face with involvement of ears (Courtesy: Dr. Piyush Kumar)
Figure 19.2
Multiple hypopigmented, slightly erythematous macules and few papules and plaques on the back (Courtesy: Dr. Piyush Kumar)
Based on the case description and the photographs what is your diagnosis?
1.
Post Kala Azar dermal leishmaniasis
2.
Lepromatous leprosy
3.
Cutaneous lymphoma
4.
Sarcoidosis
Diagnosis
Lepromatous leprosy (LL)
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