A 40-year-old multibacillary leprosy patient presents with multiple firm, shiny, skin-coloured to reddish cutaneous and subcutaneous nodules on the face and trunk that clinically resemble dermatofibromas. Slit-skin smear shows a high bacterial index. What is the correct diagnosis?

• A Erythema nodosum leprosum
• B Histoid leprosy ✓
• C Borderline tuberculoid leprosy
• D Pure neuritic leprosy

Explanation

Histoid leprosy is a distinctive variant of lepromatous leprosy in which bacilli-rich spindle-shaped histiocytes form firm, well-circumscribed nodules that mimic dermatofibromas or xanthomas. It may arise de novo or during inadequate dapsone monotherapy due to selection of resistant bacilli. Smears show a high bacterial index with solid-staining bacilli. Pure neuritic leprosy involves nerves without skin lesions, and ENL presents with tender nodules and systemic upset.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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