Diagnosis: Lepromatous Leprosy
Submitted by Alaa Saad to dermRounds Dermatology Network
Submitted by Alaa Saad to dermRounds Dermatology Network
Hypopigmented or erythematous patches/plaques with decreased sensation. Nerve enlargement. Travel to or residence in endemic areas. Armadillo exposure (Gulf Coast USA).
WHO multidrug therapy: Paucibacillary (PB): dapsone + rifampin × 6 months. Multibacillary (MB): dapsone + rifampin + clofazimine × 12 months. Type 1 reactions: prednisone. Type 2 reactions: thalidomide or prednisone.
• Granuloma annulare • Sarcoidosis • Mycosis fungoides • Tinea corporis • Vitiligo (tuberculoid leprosy) • Morphea • Secondary syphilis • Lupus vulgaris (cutaneous TB)
• Caused by Mycobacterium leprae — obligate intracellular acid-fast bacillus • Clinical spectrum (Ridley-Jopling): tuberculoid (TT) ← borderline → lepromatous (LL) • Tuberculoid: few, well-defined, hypopigmented, anesthetic plaques; paucibacillary • Lepromatous: numerous, poorly-defined papules/nodules; diffuse skin infiltration; multibacillary • Nerve involvement is the hallmark — predilection for cooler body areas (ears, nose, fingers) • Enlarged peripheral nerves on palpation is a key clinical finding • Type 1 reaction (reversal): cell-mediated; edema and inflammation of existing lesions • Type 2 reaction (erythema nodosum leprosum): humoral; tender nodules, fever, systemic symptoms • Still endemic in parts of Brazil, India, Southeast Asia, and Gulf Coast of USA (armadillo exposure)
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