A unique case of borderline lepromatous leprosy with psorias
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Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae (M. leprae.) In some cases, it can be caused by Mycobacterium lepromatosis. Which mainly affects peripheral nerve tissue, skin, and can cause disabilities. The clinical manifestation of leprosy might vary, ranging from macules (flat), infiltrates (elevated), or nodules. The elevated skin lesions on leprosy might resemble other dermatoses, such as urticaria, lupus vulgaris, annular syphilis, sarcoidosis, or psoriasis vulgaris. The nodular skin lesions can resemble cutaneous leishmaniasis, syphilis, cutaneous leukemia, or mycosis fungoides (MF).

Several authors reported psoriasiform lesions on leprosy patients and the others reported a leprosy case with clinical features resembling MF. However, histopathology of the skin lesions along with Fite's acid-fast staining revealed a large number of acid-fast bacilli (AFB) confirming the diagnosis of borderline lepromatous leprosy

Clinical manifestations of leprosy are various and may resemble other skin diseases. Skin lesions of leprosy mimicking psoriasis and mycosis fungoides (MF) that simultaneously occurs in one patient are rare.

A unique case of borderline lepromatous (BL) leprosy with severe reversal reaction manifested as psoriasis-like lesions and MF-like lesions in a 43-year-old-man is reported here.

Psoriasis-like lesions all over the body accompanied by plaques and tumor-like lesions mimicking MF on the face could be found in this patient. Histopathological examination on an MF-like lesion from the face and psoriasis-like lesions from the posterior trunk and lower extremities revealed granulomatous reaction with epithelioid cells, Langhans giant cells, and foam cells which supported the diagnosis of BL leprosy.

The patient was treated with multidrug therapy multibacillary (MDT-MB) regimen and 40 mg prednisone daily which was tapered off. Clinical improvement was observed on the 32nd day of observation as psoriasis-like and MF-like lesions became hyperpigmented macules and plaques, respectively.

Due to the rarity of the multitype skin lesions of leprosy in one patient, a diagnosis of leprosy should be suspected by the clinicians in any patients with previously described skin disorders, especially in an endemic area.

Source: https://www.sciencedirect.com/science/article/pii/S2405579419300555
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