Présentation Clinique

Clinical Setting

F 55 ans, d'origine srilankaise, connue récemment lépromateuse traitée, présente une plaque maculaire hypopigmentée du dos, et de lésion ulcéreuse de la main avec hypoesthésie.

F 55 yo. originating from Sri Lanka, recently known lepromatous, treated, complains of a macular hypopigmented plaque of the back. Presence of an ulcerative lesion of the hand with hypoesthesia.

Biopsie de la lésion du dos

Surgical biopsy of the back lesion

Pas de lésion spécifique

No specific changes

Hyperplasie de filets nerveux et infiltrat, sur les coupes profondes, dans le derme. Ziehl négatif.

Nerve hyperplasia, with mononuclear infiltrate found on recuts in the deep dermis. Acid-fast stains negative.

Diagnostic proposé:

Remaniements inflammatoires non specifiques, dans le contexte clinique, compatibles avec une lépre classée "indéterminée".

Proposed diagnosis:

Non specific changes, in the clinical setting, consistent with an indeterminate leprosy.

Arguments

poorly defined areas of slight hypopigmentation or erythema, without systemic or neural changes. The condition is only likely to be recognized readily in endemic areas where there is a high awareness of leprosy. It must be carefully distinguished from other dermatoses

scanty superficial and deep lymphohistiocytic infiltrate in the dermis, with some tendency to localization around appendages . Bacilli are infrequent, but scantily present in nerves.

For more details:

Leprosy

(Ref. Pathology of the skin, PH McKee, 3rd Ed. Elsevier-Mosby)