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Derm dx.

A 57-year-old Asian woman presented with a recent eruption of a dozen dull, erythematous papules and nodules on her extremities and numerous, well-demarcated, faintly erythematous patches on her chest and back. She had had symptoms of peripheral neuropathy for the past 10 years. What's your diagnosis?

Quebec City -- The woman's origin from Singapore and her extensive history of living in nine countries from age 26 tO 39 years until she immigrated to Canada was crucial in leading to her diagnosis of borderline lepromatous leprosy, Michael Kalisiak, M.D., reported at the annual conference of the Canadian Dermatology Association.

Her countries of residence included Iran, Trinidad, Scotland, United States, Indonesia, the Netherlands, and Norway, with brief periods in Kenya and Ecuador; some of these countries have an intermediate incidence of leprosy.

For 3 years prior to her skin manifestations, the patient visited neurologists for her neuropathic symptoms, which initially occurred as numbness and occasional pain in her left anterior thigh and later spread to her left hand and left and right lower legs. She also reported decreased grip strength in her left hand, according to Dr. Kalisiak, a second-year dermatology resident at the University of Alberta, Edmonton.

The neurologists discovered numerous motor and sensory deficits in those areas but excluded any common causes of neuropathy after extensive testing. They diagnosed her with idiopathic polyneuropathy.

On staining with hematoxylin and eosin, skin biopsies of the faint erythematous patches showed mild, nonspecific perivascular and periappendigeal infiltrate whereas biopsies from the nodules showed a heavy infiltrate in the deep dermis and beyond. Fite's stain revealed numerous lepra bacilli in the biopsy specimens (in red on biopsy of a nodule). Nasal scrapings were positive for acid-fast bacilli and polymerase chain reaction confirmed the presence of Mycobacterium leprae.

Dr. Kalisiak and his colleagues began daily treatment with 600 mg of rifampin, 100 mg of dapsone, 50 mg of clofazimine. The regimen also included gabapentin for neuropathic pain that will be continued for at least 1 year.

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Title Annotation:Skin Disorders
Author:Evans, Jeff
Publication:Family Practice News
Geographic Code:1CANA
Date:Oct 1, 2005
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