PMC5015501_01
Nodular lesions on the right leg
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F1
On clinical examination, multiple erythematous nodules and plaques of varying sizes ranging from 3 mm to 3 cm in diameter were seen on bilateral ear pinna and bony prominences of the extremities, i.e., elbows, knees, malleoli, and dorsal aspect of bilateral feet [Figure 1].
Acid-fast Bacilli in large numbers, grouped together in cigar-bundle appearance. Stained with modified Ziehl-Neelsen staining, x100
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F2
AFB in large numbers [Figure 2]. A bacterial index of 4+ (10 AFB per oil immersion field) was recorded.
Dermis showing diffuse polymorphous inflammatory infiltrate with foamy histiocytes, neutrophils, plasma cells, and lymphocytes; stained with H and E, x100
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F3
Histopathological examination of skin biopsy showed an unremarkable epidermis with underlying dermis showing a diffuse polymorphous inflammatory infiltrate coexisting with foamy histiocytes, neutrophils, plasma cells, and lymphocytes, extending from dermis to subcutis [Figure 3].
Fite-Faraco stain demonstrating acid-fast Bacilli, x100
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F4
AFB were highlighted by Fite-Faraco stain [Figure 4].