case_images: PMC10890809_01
case_images: a Clinical image showing multiple bizzare-shaped cutaneous infarcts on the dorsa of both the hands and fingers. b Clinical image showing necrosis of the pinna on the right ear.
case_images: cde-2024-0016-0001-536370_F01.jpg
case_images: PMC10890809_01_cde-2024-0016-0001-536370_F01.jpg
case_images: F1
case_images: On cutaneous examination, there was the presence of multiple irregularly-shaped ecchymotic and necrotic plaques surrounded by a dusky red zone with black adherent crust present on both arms, forearm, hand (Fig. 1a), and pinna (Fig. 1b).
case_images: Clinical image showing deep necrotic ulcers on both feet.
case_images: cde-2024-0016-0001-536370_F02.jpg
case_images: PMC10890809_01_cde-2024-0016-0001-536370_F02.jpg
case_images: F2
case_images: General examination showed diffuse infiltration of bilateral earlobes, madarosis of the ciliary and superciliary areas, and pitting edema of both hands and feet with necrotic ulceration and serous discharge from the feet (Fig. 2).
case_images: Slit-skin smear obtained from the earlobe of the left ear showing 4+ bacteriological index of acid-fast bacilli, Mycobacterium leprae.
case_images: cde-2024-0016-0001-536370_F03.jpg
case_images: PMC10890809_01_cde-2024-0016-0001-536370_F03.jpg
case_images: F3
case_images: Slit-skin smear examination obtained from the forehead and ear helices showed 4+ (10-100 bacilli in the average oil field) bacteriological index (Fig. 3).
case_images: H&E-stained section of skin biopsy from the edge of cutaneous infarct showing epidermal necrosis with dermal vascular occlusion.
case_images: cde-2024-0016-0001-536370_F04.jpg
case_images: PMC10890809_01_cde-2024-0016-0001-536370_F04.jpg
case_images: F4
case_images: Histopathological examination of the central and peripheral lesions showed foamy macrophages and the dermal vasculature showed changes suggestive of epidermal necrosis, ischemic necrotizing endarteritis obliterans, resulting in microvascular occlusion of dermal vasculature (Fig. 4).