Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge
Facial papular eruptions remain a diagnostic dilemma for the dermatologist with a wide range of inflammatory and infectious conditions manifesting in this manner. Here, we present a case of a 29-year-old, otherwise healthy man from North India with asymptomatic well-defined normoaesthetic symmetrica...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Indian Dermatology Online Journal |
| Subjects: | |
| Online Access: | http://www.idoj.in/article.asp?issn=2229-5178;year=2022;volume=13;issue=1;spage=102;epage=104;aulast=Sahni |
| _version_ | 1798024260155867136 |
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| author | Kanika Sahni Deepika Yadav Rhea Ahuja Shipra Agarwal |
| author_facet | Kanika Sahni Deepika Yadav Rhea Ahuja Shipra Agarwal |
| author_sort | Kanika Sahni |
| collection | DOAJ |
| description | Facial papular eruptions remain a diagnostic dilemma for the dermatologist with a wide range of inflammatory and infectious conditions manifesting in this manner. Here, we present a case of a 29-year-old, otherwise healthy man from North India with asymptomatic well-defined normoaesthetic symmetrical papules and plaques over the upper and mid-face of 3 months duration. Skin biopsy showed perivascular and periappendageal well-defined collections of foamy macrophages and epithelioid cells in superficial and deep dermis, characteristic of borderline lepromatous leprosy. Though acid-fast stain for lepra bacilli was negative both on lesional biopsy specimen and lesional and ear lobe slit skin smear, a 16s ribosomal ribonucleic acid (16s-r-RNA) polymerase chain reaction on skin biopsy specimen was found to be positive for lepra bacilli. A final diagnosis of borderline lepromatous leprosy in type I reaction was made and the patient received World Health Organization (WHO) multibacillary (MB) multidrug therapy along with oral steroids. This case highlights the unusual localized involvement in a case of MB leprosy lacking all the three cardinal features of leprosy, i.e. sensory loss, peripheral nerve involvement, and acid-fast bacilli positivity on biopsy or slit skin smear but diagnosed on the basis of characteristic histology and positive polymerase chain reaction results. |
| first_indexed | 2024-04-11T17:59:36Z |
| format | Article |
| id | doaj.art-47d50f4697d7435cb9afceaa6bd3eef8 |
| institution | Directory Open Access Journal |
| issn | 2229-5178 |
| language | English |
| last_indexed | 2024-04-11T17:59:36Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Dermatology Online Journal |
| spelling | doaj.art-47d50f4697d7435cb9afceaa6bd3eef82022-12-22T04:10:33ZengWolters Kluwer Medknow PublicationsIndian Dermatology Online Journal2229-51782022-01-0113110210410.4103/idoj.IDOJ_66_21Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challengeKanika SahniDeepika YadavRhea AhujaShipra AgarwalFacial papular eruptions remain a diagnostic dilemma for the dermatologist with a wide range of inflammatory and infectious conditions manifesting in this manner. Here, we present a case of a 29-year-old, otherwise healthy man from North India with asymptomatic well-defined normoaesthetic symmetrical papules and plaques over the upper and mid-face of 3 months duration. Skin biopsy showed perivascular and periappendageal well-defined collections of foamy macrophages and epithelioid cells in superficial and deep dermis, characteristic of borderline lepromatous leprosy. Though acid-fast stain for lepra bacilli was negative both on lesional biopsy specimen and lesional and ear lobe slit skin smear, a 16s ribosomal ribonucleic acid (16s-r-RNA) polymerase chain reaction on skin biopsy specimen was found to be positive for lepra bacilli. A final diagnosis of borderline lepromatous leprosy in type I reaction was made and the patient received World Health Organization (WHO) multibacillary (MB) multidrug therapy along with oral steroids. This case highlights the unusual localized involvement in a case of MB leprosy lacking all the three cardinal features of leprosy, i.e. sensory loss, peripheral nerve involvement, and acid-fast bacilli positivity on biopsy or slit skin smear but diagnosed on the basis of characteristic histology and positive polymerase chain reaction results.http://www.idoj.in/article.asp?issn=2229-5178;year=2022;volume=13;issue=1;spage=102;epage=104;aulast=Sahnicentrofacial eruptionfoamy macrophageslocalized multibacillary leprosypolymerase chain reaction |
| spellingShingle | Kanika Sahni Deepika Yadav Rhea Ahuja Shipra Agarwal Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge Indian Dermatology Online Journal centrofacial eruption foamy macrophages localized multibacillary leprosy polymerase chain reaction |
| title | Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge |
| title_full | Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge |
| title_fullStr | Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge |
| title_full_unstemmed | Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge |
| title_short | Symmetrical centrofacial erythematous plaques and papules: A clinicopathological challenge |
| title_sort | symmetrical centrofacial erythematous plaques and papules a clinicopathological challenge |
| topic | centrofacial eruption foamy macrophages localized multibacillary leprosy polymerase chain reaction |
| url | http://www.idoj.in/article.asp?issn=2229-5178;year=2022;volume=13;issue=1;spage=102;epage=104;aulast=Sahni |
| work_keys_str_mv | AT kanikasahni symmetricalcentrofacialerythematousplaquesandpapulesaclinicopathologicalchallenge AT deepikayadav symmetricalcentrofacialerythematousplaquesandpapulesaclinicopathologicalchallenge AT rheaahuja symmetricalcentrofacialerythematousplaquesandpapulesaclinicopathologicalchallenge AT shipraagarwal symmetricalcentrofacialerythematousplaquesandpapulesaclinicopathologicalchallenge |