|THROUGH THE LENS
|Year : 2014 | Volume
| Issue : 5 | Page : 61-62
Molluscuoid lesions over the body
Pradeep S Nair
Department of Dermatology and Venereology, Government Medical College, Trivandrum, Kerala, India
|Date of Web Publication||13-Nov-2014|
Dr. Pradeep S Nair
Department of Dermatology and Venereology, Government Medical College, Trivandrum - 695 011, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nair PS. Molluscuoid lesions over the body. Indian Dermatol Online J 2014;5, Suppl S1:61-2
A 42-year-old male presented with multiple asymptomatic raised skin lesions of 8 months duration. The lesions first appeared on the posterior aspect of the trunk and later involved the forearms, face, and ears. He also noticed a non-healing ulcer over the left heel for the past 2 months. On examination, he had multiple discrete skin-colored, smooth, shiny, dome-shaped papules, some of them resembling molluscum contagiosum [Figure 1], arising from an apparently normal-looking skin and distributed on the posterior trunk, upper extremities [Figure 2], face, and ear lobes. The patient also had a well-defined ulcer covered with slough over the left heel. The sensations were intact on the papules. The patient had glove and stocking type of anesthesia, while the ulnar, common peroneal, and tibial nerves were thickened bilaterally, but were non-tender. Slit-skin smears from the ear lobes, papules, and normal skin were positive for acid-fast bacilli (AFB), the morphological index being 60% from all the sites, while the bacterial index was 6 + from all the sites. Skin biopsy from a papule showed a well-circumscribed collection of spindle-shaped histiocytes in the dermis, arranged in nodular aggregates [Figure 3], while Wade-Fite stain showed the spindle-shaped histiocytes to be packed with AFB [Figure 4]. With these features, a final diagnosis of histoid leprosy (HL) was made.
| Discussion|| |
HL, a rare variant of lepromatous leprosy (LL), presents with smooth, shiny papules arising from an apparently normal-looking skin, compared to LL where the papules arise from an infiltrated skin.  HL is described in patients who had taken dapsone monotherapy, inadequate therapy, and due to drug resistance. However, de novo cases have also been described.  HL usually presents with localized rather than generalized lesions, and can thus be missed clinically. The papules and nodules are usually distributed over the trunk and extremities (favoring the elbows and knees), and the face. Ear lobe infiltration and lepra reactions are usually rare. Histopathology shows a well-defined collection of spindle-shaped histiocytes in the dermis, packed with AFB which are longer and narrower with thin tapering ends, and absence of globi.  HL may present as molluscum contagiosum, xanthoma, and tumor-like lesions, and can be misdiagnosed clinically.  HL in most cases responds to multibacillary-multidrug therapy, but in addition to it, some cases may require ofloxacin due to the high bacillary load.  Since HL can mimic many dermatoses, a high degree of clinical suspicion is required.
| References|| |
Wade HW. The histoid variety of lepromatous leprosy. Int J Lepr 1963;31:129-42.
Nair SP, Kumar GN. A clinical and histopathological study of histoid leprosy. Int J Dermatol 2013;52:580-6.
Sehgal VN, Srivastava G. Status of histoid leprosy-a clinical, bacteriological, histopathological and immunological appraisal. J Dermatol 1987;14:38-42.
Nair SP, Moorthy KP, Suprakasan S, Jayapalan S, Mini G. Histoid leprosy-unusual presentation. Int J Dermatol 2006;45:433-4.
Sehgal VN, Sardana K, Dogra S. The imperatives of leprosy treatment in pre- and post-leprosy elimination era: appraisal of changing scenario to current status. J Dermatol Treat 2008;19:82-91.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]