A leprosy patient presents with sharply demarcated, shiny, firm cutaneous and subcutaneous nodules resembling dermatofibromas distributed over normal-appearing skin. Slit-skin smear from the nodule shows a very high bacterial index. Histopathology shows spindle-shaped macrophages arranged in whorls. This variant is called:

• A Pure neuritic leprosy
• B Borderline tuberculoid leprosy
• C Histoid leprosy ✓
• D Indeterminate leprosy

Explanation

Histoid leprosy is a rare variant of lepromatous leprosy in which bacilli proliferate in a fibrohistiocytic stroma, producing discrete firm nodules that mimic benign skin tumours. Despite the localized appearance, the bacterial index is very high and the lesion behaves as multibacillary disease requiring MB multidrug therapy. Borderline tuberculoid leprosy shows granulomatous inflammation with few bacilli, indeterminate leprosy shows nonspecific perineural infiltrates, and pure neuritic leprosy lacks skin lesions entirely.

Reference: IAS Textbook of Dermatology, 4th ed.

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