PMC3773570_01
Unmasking of occult leprosy. A, Ill-defined erythematous forearm plaque noted 6 days after transplant. B, Biopsy specimen revealed a perivascular and periadnexal lymphocytic infiltrate (hematoxylin-eosin, original magnification x200). C, A retrospective Fite stain subsequently demonstrated many acid-fast bacilli consistent with the diagnosis of leprosy (original magnification x400).
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F1
Examination revealed a small, ill-defined, indurated, erythematous plaque on the left forearm (Figure 1A) and an annular erythematous plaque with central clearing and fine scale measuring several centimeters on the left bicep. A biopsy specimen from the left forearm showed a sparse, superficial and deep, perivascular and periadnexal infiltrate for which a specific diagnosis could not be rendered (Figure 1B). A retrospective Fite stain performed on the initial skin biopsy specimen taken 6 days after transplant demonstrated acid-fast bacilli in the perivascular and perineural dermis in a microscopic pattern consistent with an occult undefined leprosy (Figure 1C).
Leprosy type 1 reaction. A, Annular plaque on the arm. B, Indurated papules and plaques on the tragus. C, Biopsy specimen demonstrated a perivascular and periadnexal infiltrate of lymphocytes and foamy histiocytes (hematoxylin-eosin, original magnification x200). A Fite stain (not shown) demonstrated many acid-fast bacilli.
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F2
The patient was discharged and presented to the outpatient clinic 4 months later with marked induration of the previously noted areas plus new erythematous to violaceous papules and plaques on the right deltoid, cheek, and tragus (Figure 2A and 2B). Examination of a second biopsy specimen revealed clusters of epithelioid and foamy macrophages (Figure 2C) shown by Fite stain to contain many acid-fast bacilli.