Histoid leprosy is a distinct clinicopathological entity. Which of the following best describes its characteristic features?

• A Tuberculoid granulomas with caseation and sparse AFB
• B Perineural granulomas with onion-skin appearance
• C Well-defined nodular lesions with spindle-shaped histiocytes containing massive AFB ✓
• D Foam cells with globi forming in dermis with no organized granuloma

Explanation

Histoid leprosy, described by Wade, occurs in lepromatous leprosy patients who have relapsed due to dapsone resistance or as a de novo presentation. Clinically it shows discrete, well-defined, dome-shaped nodules. Histologically, spindle-shaped histiocytes arranged in whorls with massive bacterial load (BI 4+ to 6+) are characteristic. It is distinguished from ordinary LL by organized histiocyte arrangement. Dapsone monoresistance is a key association.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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