Histoid leprosy with Type 1 reaction

A sixty-one years old man presented with multiple nodules and plaques of different sizes, distributed on the face, trunk, buttocks and lower extremities. He had a history of prior treatment with dapsone monotherapy for Lepromatous leprosy (LL) thirty years ago. The patient was diagnosed with Histoid Borderline-Lepromatous Leprosy after clinical examination and the results of slit skin smears and histopathology that revealed histiocytic granuloma with spindle-shaped, non vacuolated histiocytes. Abundant acid-fast bacilli (AFB) were visible on Fite’s stain. Twelve weeks later, he developed a large erythematous plaque on axillary region and histopathology showed epitheliod and giant cells on background of the histiocytic granuloma. The diagnosis of type 1 leprosy reaction was made and the patient was treated with prednisone at 1 MG/kg body weight/day. The lesions regressed within four weeks and prednisone was slowly tapered (10 mg every 30 days) over four months. The anti-leprosy treatment was stopped after 24 months. Histoid leprosy rarely involves leprosy reactions. More frequently type 2 reactions were reported, but type 1 reactions are also possible as reported here.