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Painful Plaques and Nodules on the Face, Neck, and Right Wrist of a 51-Year-Old Man—Diagnosis
Arch Dermatol. 2005;141:389-394.
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Diagnosis: Borderline tuberculoid leprosy with a type I downgrading reaction.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
The biopsy specimen demonstrated a moderately dense superficial and deep perivascular and perineural lymphocytic and histiocytic infiltrate. Focal, nonnecrotizing granuloma formations were present. A Fite stain showed the presence of acid-fast bacilli within nerve trunks (Figure 3). The bacterial index was 2 (1-10 bacilli per 1 oil-immersion field). The Ziehl-Neelsen stain was negative for acid-fast bacilli.
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While there are multiple treatment regimens for multibacilliary disease, we chose the World Health Organization’s system for the treatment of multibacilliary disease. It included a 2-year course of the following: dapsone (100 mg/d, unsupervised [causing eventual elimination of the infection, even if resistant to rifampin]); clofazimine (50 mg/d, unsupervised, and 300 mg monthly, supervised [bacteriostatic]); and rifampin (600 mg monthly, supervised [bacteriocidal, even if resistant to dapsone]). Because of the risk of permanent nerve damage with the downgrading reaction, prednisone therapy (40 mg/d for 2 months) was initiated, followed by . . . [Full Text of this Article] DISCUSSION
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Painful Plaques and Nodules on the Face, Neck, and Right Wrist of a 51-Year-Old Man—Quiz Case
Anastasia M. Canacci, Sharon Longshore Thornton, Apra Sood, and Wilma Bergfeld
Arch Dermatol. 2005;141(3):389-394.
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