Evaluation of S-100 immunostaining in the demonstration of nerve changes in tuberculoid and borderline tuberculoid leprosy - A descriptive, prospective and retrospective analytical study

S-100 immunohistochemical staining may detect nerve involvement in early stages of tuberculoid spectrum of leprosy. This study investigated the use of S-100 in early diagnosis of the tuberculoid and borderline tuberculoid leprosy and compared its sensitivity with hematoxylin and eosin (HE) stains in discerning the nerve involvement. To study the different histopathological patterns of nerve involvement in tuberculoid and borderline tuberculoid leprosy on S-100 immunostaining and also to compare the sensitivity of HE stain with S-100 immunostain in discerning the nerve involvement in these cases. This was a descriptive, prospective and retrospective analytical study, which included patients with tuberculoid spectrum of leprosy. Histopathological examination (HPE) and immunohistochemical (IHC) analysis were performed on all skin biopsies using HE stain and S-100 immunostain, respectively. Then the sensitivities of both the stains in discerning the nerve involvement were calculated and the data was analyzed using SPSS software version 22 by applying chi-square test. The study included a total of 58 patients [tuberculoid (n=28), borderline tuberculoid (n=30)]. The mean age was 43 yrs. The most common clinical manifestation was hypopigmented patches (n=40, 70%) with loss of sensation (n=39, 68.3%). HPE revealed 36 cases with well-defined granulomas, 22 cases with ill-defined granulomas and 41 cases with nerve destruction. IHC analysis showed four different patterns of nerve damage (fragmented, n=32; infiltrated and fragmented, n=14; infiltrated, n=10; intact, infiltrated and fragmented; n=1). The sensitivity and positive predictive value (PPV) of HE staining in delineating the nerve involvement were 68.96% and 100%, respectively. Whereas, the sensitivity and PPV of S-100 IHC were 100% each. Less number of cases. Use of S-100 IHC along with HPE aids in early, accurate and confirmatory diagnosis.

TYPE 1 LEPRA REACTION MIMICKING BULLOUS FIXED DRUG ERUPTION

Leprosy is a chronic infectious disease with varied clinical presentations. Leprosy reactions generally manifest as erythematous edematous tender plaques or evanescent erythematous nodules with or without neuritis. Bullous type of reactions are rare in leprosy. We hereby report a case of borderline tuberculoid leprosy with bullous eruption. A 24 year old male, known case of borderline tuberculoid leprosy who has completed MB MDT after which he continued Dapsone and Rifampicin for another 6 months, now presented with acute onset of fever, malaise, swelling of both feet and painful raised reddish lesions followed by uid lled lesions over the pre existing lesions of leprosy i.e.,on right ear and right sole since 10 days. There is no history of similar episodes. On examination patient looks toxic with bilateral pitting type of pedal edema. Cutaneous examination revealed a single well dened erythematous plaque with vesicles and crusting over pinna and helix of right ear. A single well dened erythematous plaque with central vesicle surrounded by edematous ring noted over medial aspect of right sole. No other skin lesions & mucosal lesions were present. Nikolsky and bulla spread sign was negative. Nerve examination revealed ulnar & common peroneal nerve thickening and tenderness over right side. Routine investigations revealed raised ESR & bilirubin levels. Tzanck smear and slit skin smear was negative. Histopathological examination showed dermal edema with few ill dened granulomas. Based on the above ndings a diagnosis of BT leprosy in Type 1 reaction with bullous eruption was made which is rare after completing MB MDT. However it needs to be differentiated from other causes of bullous eruption

Significance of histopathology in the evaluation of paucibacillary leprosy

Background: Leprosy patients are classified into paucibacillary and multibacillary types on the basis of the number of skin lesions for the purpose of therapy. Patients with 1–5 skin lesions are clinically categorized as paucibacillary for treatment purposes. Aim: To study paucibacillary leprosy cases and compare clinical details with histopathological findings. Materials and methods: Three and half year study involving 130 patients of paucibacillary cases of leprosy diagnosed clinically and based on the 1–5 skin lesions was included in this study after ethical clearance and taking informed consent from patients. A number of skin lesions were recorded. Skin biopsies were taken in all patients. Biopsies were evaluated for the type of pathology and acid fast bacilli (AFB) status. Results: Of 130 patients, 81(62.3%) were males and 49(37.6%) were females. Majority of the clinically classified cases were borderline tuberculoid leprosy. The histological diagnoses were: TT 19(14.6%), BT 40(30.7%), IL 51(39.2%) and No evidence of leprosy 20(15.3%). AFB were found in 3(15.3%) out of 130 skin biopsies and all were borderline tuberculoid leprosy. Conclusion: Tissue diagnosis play a significant role in the diagnosis of leprosy. Early and borderline cases of leprosy poses a diagnostic difficulty to label only on clinical basis, so histopathological evaluation is must for confirming the diagnosis in doubtful cases of leprosy.

A HISTOPATHOLOGICAL STUDY OF LEPROSY ALONG WITH CLINICAL CORRELATION.

Background: Leprosy or Hansen’s disease is a chronic infectious disease that mainly affects skin and peripheral nerves. Histopathology and demonstration of lepra bacilli is an essential tool to supplement clinical examination and diagnosis for correct classification and therefore treatment of patients. Aim: To study histopathology of leprosy cases and identify histological types in patients in a tertiary care centre, Asram hospital in Eluru. Materials and Methods: 18 skin biopsies diagnosed as leprosy over a period of two years from January 2018 to December 2019 were studied. Haematoxylin-eosin and Fite-Faraco staining for demonstrating lepra bacilli were done. Results: Male to female ratio of patients was 4.5:1. Maximum number of cases was seen in the 3rd and fourth decades of life. The commonest histological type was borderline tuberculoid (5 cases, 28%) and indeterminate type, lepromatous type (3 cases, 16%); followed by tuberculoid leprosy and erythema nodosum leprosum (2 cases, 11%), the least common cases were of lepromatous leprosy to borderline tuberculoid leprosy (1cases, 6%). The most common site was upper limb (26%). All 3/18(24%) patients with affected nerves showed ulnar and auricular nerve involvement. Hypopigmented, anaesthetic plaque was the commonest clinical feature followed by erythematous lesions. All cases of borderline tuberculoid, borderline lepromatous, lepromatous, midboderline and indeterminate showed acid-fast bacilli on Fite stain. Tuberculoid cases showed well-formed granulomas, borderline tuberculoid type showed additional feature of giant cells and lepromatous types showed grenz zone and no granulomas. Conclusion: Histopathological examination is the gold standard for accurate diagnosis and typing of leprosy. It should be done in all leprosy cases presenting to the clinician.