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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA

A Journal on Dermatology and Sexually Transmitted Diseases


Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 2006 December;141(6):541-4

language: English

Lepromatous leprosy. A case report

Mozzillo R. 1, Colasanti P. 1, Cordedda M. 1, Zanchini R. 1, Berruti V. 1, Spanò G. 1, Picciotti E. 2, Berruti G. 1

1 Unit of Dermatology S. Gennaro Hospital ASL Napoli 1, Naples, Italy
2 Unit of Histopathologyy Vecchio Pellegrini Hospital ASL Napoli 1, Naples, Italy


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We present the case of a male patient aged 68, Italian, suffering from lepromatous leprosy, a form of leprosy brought on by a deficiency in the individual’s cell-mediated immunity. The man, who had lived in Venezuela for about 20 years, presented a widespread eruption of erythematous plaques that were not associated with any other symptoms. A biopsy of the lesions revealed the presence of a granulomatous infiltrate in the dermis, containing foamy microphages and some lymphocytes. Ziehl-Neelsen staining revealed the presence of acid-alcohol fast bacilli in the cytoplasm of the macrophages. A search for microbacteria in the nasal mucosa using Ziehl-Neelsen staining gave a positive result, confirming the presence of acid-alcohol fast bacilli. The nasal cartilage also proved to be perforated. As a result, on the basis of the clinical, histopathological and bacteriological data, lepromatous leprosy was diagnosed. The patient was sent to a centre specialised in treating Hansen’s disease to start specific chemotherapy. Leprosy can appear in a variety of manifestations, which may go unrecognised, so it is important to perform a differentiated diagnosis with other skin diseases, particularly in countries where the disease is not endemic. This diagnosis must, therefore, be borne in mind in the presence of skin lesions and/or heat and pain anaesthesia. The case described offers the opportunity to underline the need to gather a detailed medical history regarding any time spent in endemic areas in the last 10-15 years, in the event of a suspected case. We also illustrate new theories regarding cell-mediated immunological mechanisms involved in the infection that affect the clinical and histopathological polymorphism of Hansen’s disease.

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