PMC6112268_01
Coronal computed tomography scan of the abdomen showing marked gastric distension and splenomegaly.
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Computed tomography (CT) showed scattered focal pulmonary infiltrates, splenomegaly, and a markedly distended stomach without an obvious focus of mechanical obstruction (Figure 1).
(a) Papular lesion with excoriations from itching on the patient's forearm. (b) The left foot with dark macules and papules. (c) Acanthosis nigricans around the patient's neck with dry, scaly papules along the lateral face. (d) The edematous hand with pigmented macules.
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She was also noted to have diffuse small nodular lesions most apparent on her hands, feet, lower legs, and face (Figure 2).
The coronal computed tomography scan of the abdomen showing persistent gastric dilatation.
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Repeat CT imaging showed persistent gastric dilation and splenomegaly (Figure 3).
(a) Low-power image of epidermis, dermis, and subcutaneous tissue within the subcutaneous nodule showing granulomatous inflammation in the deep dermis and subcutis. (b) High-power image of the inflammation. (c) Fite's stain demonstrating the M. leprae bacilli.
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Skin biopsies of multiple lesions were obtained and sent for pathology and culture (Figure 4). AFB with changes consistent with lepromatous leprosy due to M. leprae (Figure 4). Additionally, the serial sputum samples were positive for AFB, and culture of the skin sample for AFB showed evidence of growth within a few days, suggesting Mycobacterium tuberculosis (MTB) pulmonary infection and possibly disseminated MTB given selectivity of the culture medium.