PMC3501807_01
(a-c) Histoid lesions: flesh colored-erythematous papules, nodules, plaques, and patches over back, trunk, arms, and elbows (d&e) Histoid lesions after 6 months' treatment (f) Histoid lesions at 9-month followup.
CRIM.PATHOLOGY2012-219421.001.jpg
PMC3501807_01_CRIM.PATHOLOGY2012-219421.001.jpg
fig1
A 64-year-old farmer presented with shiny, nonitching nodules, papules, and plaques over various parts of body especially prominent over trunk, lower back, buttocks, arms, and legs but involving face, chest wall, elbow, and knee, counting approximately 42 in number (Figures 1(a)-1(c)). In the past eleven-month treatment, the patient has responded well (Figures 1(d) and 1(e)).
(a) Atrophic epidermis with underlying histoid nodule mimicking benign fibrohistiocytic lesion. Narrow grenz zone and intact hair follicle are appreciable (Leishman, x 40); (b) Leproma at higher magnification depicting spindle-round-polygonal cells (Leishman, x 400); (c) Leproma depicting intact small dermal nerve entrapped within spindle-polygonal vacuolated cells (Leishman, x 400); (d) Myriads of AFB-clusters and singly scattered (Ziehl Neelsen, x 1000).
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PMC3501807_01_CRIM.PATHOLOGY2012-219421.002.jpg
fig2
Within the mass of spindle-shaped histiocytes, rounded-polygonal plump histiocytic cells with vacuolated cytoplasm along with occasional giant cells were noticed (Figures 2(a)-2(c)). However, Ziehl Neelsen (ZN) staining (5% sulphuric acid) revealed abundant, mostly solid, acid fast bacilli (AFB) within the histiocytes and endothelial cells, as well as lying extracellularly (Figure 2(d)).