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Aug 2012

Fleshy Asymptomatic Cutaneous Nodules in a Young Adult Male—Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

Arch Dermatol. 2012;148(8):947-952. doi:10.1001/archderm.148.8.947-h

Histopathologic examination revealed thinned-out epidermis with marked accumulation of foamy histiocytes in the dermis (Figure 2) with some areas showing prominent spindling of histiocytes. Ziehl-Neelsen staining for lepra bacilli was strongly positive, showing clumps of acid-fast bacilli (Figure 3). Results from a slit-skin smear examination from the lesions also revealed acid-fast bacilli with a bacteriological index higher than 5 and a morphologic index of 15%, indicating a high bacillary load and high viability of lepra bacilli. The right greater auricular nerve and right lateral popliteal nerve were found to be thickened but nontender. No sensory deficit or motor weakness was apparent at any site. A diagnosis of HL was made, and the patient was started on World Health Organization–recommended multidrug multibacillary therapy (rifampicin, 600 mg, and clofazimine, 300 mg, once monthly, and dapsone, 100 mg, and clofazimine, 50 mg, daily). In addition, the patient's close family members were asked to report for screening of leprosy.

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