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case_images: A, B, Skin findings during first visit. Erythematous nodules and papules on the upper and lower limb, some with superficial ulceration. C, D, Lesions aspect after 6 months of initiating treatment for leprosy. Notable clinical improvement with clearance of most elevated lesions, with some persistence of erythematous macules.
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case_images: On initial physical examination, she displayed skin xerosis with multiple red-brown nodules over the forearms, both ankles and feet, some with mild scaling and superficial ulceration (Fig 1, A, B). At 6-month follow-up the patient was found to be markedly improved (Fig 1, C, D).
case_images: Forearm nodule. A, Hematoxylin and eosin staining (10x magnification) showing chronic granulomatous inflammation with abundant lymphohistiocytic infiltrate and vacuolated cells in the dermis, separated from the epidermis by a normal collagen band known as Unna's band typical of lepromatous leprosy. B, Fite-Faraco staining (100x magnification) depicting abundant individual and grouped (globi) acid-fast bacilli. Photos courtesy of Dr Ricardo Rueda, Department of Pathology, Universidad del Valle.
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case_images: Histopathology study (Fig 2, A) revealed chronic granulomatous inflammation with globi grouped acid-fast bacilli on Fite-Faraco staining (Fig 2, B), confirming a diagnosis of lepromatous leprosy (multibacillary).
case_images: Summary timeline of clinical events. ELISA, Enzyme-linked immunosorbent assay; HIV, human immunodeficiency virus; PCR, polymerase chain reaction; RPR, rapid plasma reagin; TT, treponemal test.
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case_images: For timeline details see Fig 3.