Lepromatous leprosy masquerading as anetoderma in a boy

T Muhammed Razmi¹ , Tarun Narang¹ , Debajyoti Chatterjee² , Sunil Dogra¹ , Uma Nahar Saikia²

¹ Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
² Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Tarun Narang
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
India

An adolescent presented with asymptomatic loose outpouching of the skin, without any antecedent lesions. These well-defined atrophic plaques were distributed on the upper arm, thighs and neck [Figure - 1]a and [Figure - 1]b. General examination revealed infiltrated earlobes and symmetrical peripheral nerve thickening without associated sensory impairment. There were no hypopigmented/erythematous patches. Nerve conduction study revealed sensory-motor polyneuropathy. Slit-skin-smear from one of the atrophic lesions from the left upper arm demonstrated acid fast bacilli with a bacillary index of 5+. Histopathology of the same lesion showed peri-adnexal and peri-neuro-vascular lymphohistiocytic collections [Figure - 2]a, along with degeneration of collagen and elastin [Figure - 2]b and positive-modified Ziehl-Neelsen staining. Syphilis, human immunodeficiency virus and anti-phospholipid antibodies screening were unremarkable. Anetoderma in polar lepromatous leprosy is extremely rare. In the absence of reactions to suggest neutrophil-mediated elastolysis, elastolytic enzymes produced by lesional macrophages may be the reason for anetoderma.

Figure 1: (a) Anetodermic lesion on the arm. (b) Close-up image of one of the thigh lesions

Figure 2: (a) Normal epidermis and peri-vascular and peri-appendageal lymphohistiocytic collection with altered connective tissue fibers in the dermis (hematoxylin and eosin, ×100) (b) Collagen and elastin degeneration in the dermis(elastic van Gieson, ×200)

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