Histoid leprosy with filariasis

Kamal Aggrawal, VK Jain, Surbhi Dayal

 Department of Skin, V. D and Leprosy, Pt. BDS Postgraduate Institute of Medical Sciences, Rohtak-1 24001 (Haryana), India

Correspondence Address:
V K Jain
11/9J, Medical Enclave, Pt. BDS PGIMS, Rohtak-124001 (Haryana)
India

Introduction

Histoid leprosy, originally described by Wade in 1963, [1] is generally regarded as a distinct clinico-pathological entity. [2] It presents as isolated firm, round or oval, shiny, glistening erythematous nodules or plaque-like lesions which are sharply delimited from the surrounding apparently normal looking skin. We came across a case of filariasis taking treatment in the form of diethyl carbamazine citrate who developed histoid leprosy during the course of the disease. There was no history of previous anti-leprotic treatment.

Case Report

A 26-year-old male, resident of Bihar and labourer by occupation, developed intermittent pyrexia with early morning rise of temperature associated with rigors and chills, unilateral pitting edema of right lower limb below knee joint and bilateral inguinal lymph node enlargement one year back [Figure - 1]. Blood counts showed eosinophilia and blood smear for microfilaria was positive. Patient was diagnosed as a case of filariasis and was treated with diethyl carbamazine citrate in the dose of 300mg per day in three divided doses. After 8 months, the patient developed multiple shiny, glistening, firm, intradermal, hypopigmented papulonodular lesions, sharply demarcated from the surrounding apparently normal looking skin, over the upper and lower extremities and face with comparatively fewer lesions on the front and back of the trunk [Figure - 1]. The lesions were variable in size ranging upto 3 cm in diameter, oval to round in shape with no impairment of pain, touch and temperature sensations. Similar papulonodular lesions were also present on both ear lobes. At places, few well -defined erythematous plaques variable in size, ranging from 1 x 15 cm to 2 x 2 cm with impairment of pain, touch and temperature sensations were also present. There was no change in the appearance of the lesions since their onset. The right lateral popliteal nerve was found to be enlarged, cord-like and non-tender.

Patient did not have any history of previous anti-leprotic treat-ment. There was no history of previous episodes sug-gestive of lepra reac-tions. Family history was negative. Slit-skin smear for acid-fast bacilli was strongly positive with a bacterial index of 5+. Skin biopsy showed features of histoid lep-rosy with characteristic interlacing bundles of spindle shaped cells arranged in a criss-cross fashion. Staining for acid fast bacilli was positive.

Discussion

A case of filariasis developing histoid leprosy "de-novo" is being presented. Histoid leprosy is an unusual variant of lepromatous leprosy presenting as firm, round or oval, characteristically glistening, very well-defined nodules, developing on the skin of patients whose disease is relapsing either because they have stopped treatment or because their M. leprae have become drug resistant. But, histoid leprosy may be seen in patients who are presenting for the first time and have not taken any previous antileprotic treatment i. e. developing "de-novo". This uncommon variant of leprosy i. e. histoid leprosy, developing ′de-novo′ in a case of filariasis without any previous history of leprosy, anti-leprotic treatment or family history, in a low endemic area for leprosy and filariasis emphasizes the co-existence of the two conditions even in this part of the country especially due to a high influx of immigrant labour population from high endemic areas as leprosy and filariasis have the same endemic foci. Like any other febrile condition, filariasis has been reported to precipitate lepra reactions. [1],[4] but no such reactions were noted during the course of the disease.

To the best of our knowledge, the co-existence of histoid leprosy with filariasis has not been reported in the past. Thus, this case is being reported for the rarity of its occurrence.

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