De-Novo Presentation of Histoid Leprosy on an Unusual Site

Histoid Leprosy (HL) is a rare variant of Lepromatous Leprosy, occurring in long-standing cases, mostly in a background of acquired drug resistance. Patients usually present with sudden onset multiple nodules and plaques, most often involving the skin and subcutaneous tissue of trunk and lower limbs. Here we report an unusual case of de novo (without any history of prior anti-leprotic therapy) HL, arising as multiple nodules in the face. The histopathology of the lesion showed collection of spindled macrophages in the dermis, oriented in a storiform-like pattern. A possibility of HL was considered and the diagnosis was confirmed by performing a modified ZN stain (Wade-Fite stain) on the biopsy material, which revealed the presence of acid-fast bacilli (AFB) with a bacillary index of 6. Then the patient was put on multibacillary multi-drug chemotherapy and was thereby cured.