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Tuberculoid Leprosy

30-year-old woman presented with a 4-month history of a rash Mohsen Esfandbod, M.D.
on her back. The physical examination revealed multiple large, annular, hypo- Tehran University of Medical Sciences
pigmented, atrophic macules with well-defined, erythematous, raised borders. Tehran, Iran
The lesions were hairless, hypohidrotic, and anesthetic and had developed at a slow sfandbod@sina.tums.ac.ir
and progressive pace. There was no peripheral-nerve enlargement. Histopathological
analysis of a skin-biopsy specimen revealed well-developed epithelioid granulomas,
lymphocytes, and Langerhans cells surrounding neurovascular structures within the
papillary dermis. Dermal nerves were swollen and destroyed. No acid-fast bacilli were
detected on modified ZiehlNeelsen staining. On the basis of clinical and histologic
findings, the condition was diagnosed as tuberculoid leprosy. The clinical manifestations of leprosy depend on the nature of the hosts immune response to infection
with Mycobacterium leprae and range from lepromatous leprosy (uncontrolled replication with nerve damage from high-titer infection) to tuberculoid leprosy (nerve and
organ damage predominantly from the host granulomatous immune response). The
patient had no known contact with anyone with leprosy, which has a prevalence of
less than 1 in 100,000 in Iran. She was treated with a 6-month course of rifampin
and dapsone with nearly complete clearing of the skin lesions.

Copyright 2011 Massachusetts Medical Society.

n engl j med 364;17

nejm.org

april 28, 2011

The New England Journal of Medicine

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Copyright 2011 Massachusetts Medical Society. All rights reserved.

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