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Presented by Ralph Hruban, M.D. and prepared by Andrea Subhawong, M.D.
Case 6: This child from Africa was visiting the United States.
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1. Question
Week 391: Case 6
This child from Africa was visiting the United States. His parents took him to the hospital because they noted that he had skin nodules.images/5.4.09.06a.jpg
images/5.4.09.06b.jpg
images/5.4.09.06c.jpg
images/5.4.09.06d.jpgCorrect
Answer: Lepromatous leprosy
Histology: The dermis is filled with sheets of foamy histiocytes. Well-formed granulomata are not seen. An acid fast stain reveals numerous organisms filling the foamy macrophages.
Discussion: Leprosy is caused by Mycobacterium leprae. A distinctive feature of leprosy is the distribution of the lesions in the cooler parts of the body (skin prominences, URT, peripheral nerves, testes). There are two forms of leprosy, tuberculoid leprosy and lepromatous leprosy.
Lepromatous leprosy is characterized by a weak immune response with numerous bacilli and sheets of macrophages. These patients typically have a non-reactive Lepromin test.
Tuberculoid leprosy is characterized by a strong immune response. Few bacilli are present, and clinical manifestations are usually seen in only one or two nerves and associated skin, which develop an intense granulomatous reaction. Patients with the tuberculoid form of leprosy have a reactive Lepromin test.
Muscular and sensory nerve damage from infected nerves cause deformities.
The cases for this conference were kindly provided by Dr. Vincent Rouleau of the Pathology Laboratory, New Caledonia. His sharing of these interesting cases is greatly appreciated.
The case histories were fabricated to protect patient confidentiality.
Incorrect
Answer: Lepromatous leprosy
Histology: The dermis is filled with sheets of foamy histiocytes. Well-formed granulomata are not seen. An acid fast stain reveals numerous organisms filling the foamy macrophages.
Discussion: Leprosy is caused by Mycobacterium leprae. A distinctive feature of leprosy is the distribution of the lesions in the cooler parts of the body (skin prominences, URT, peripheral nerves, testes). There are two forms of leprosy, tuberculoid leprosy and lepromatous leprosy.
Lepromatous leprosy is characterized by a weak immune response with numerous bacilli and sheets of macrophages. These patients typically have a non-reactive Lepromin test.
Tuberculoid leprosy is characterized by a strong immune response. Few bacilli are present, and clinical manifestations are usually seen in only one or two nerves and associated skin, which develop an intense granulomatous reaction. Patients with the tuberculoid form of leprosy have a reactive Lepromin test.
Muscular and sensory nerve damage from infected nerves cause deformities.
The cases for this conference were kindly provided by Dr. Vincent Rouleau of the Pathology Laboratory, New Caledonia. His sharing of these interesting cases is greatly appreciated.
The case histories were fabricated to protect patient confidentiality.
