Oral manifestation of lepromatous leprosy: diagnosis and management

Excerpt

A 40-year-old man complained about having asymptomatic non-healing oral ulcers for the past 6 months. His familial and medical histories were unremarkable; serological tests were negative for HIV. Physical examination revealed soft, pink granulous lesions involving the upper lip (Fig. 1a) and anterior edentulous alveolar ridge (Fig. 1b). There were also shiny patches on the skin of the back, chest, abdomen, and upper and lower limbs (Fig. 1c). A provisional clinical diagnosis of granulomatous disease disease (such as paracoccidioidomicosis, syphilis, leishmaniasis, tuberculosis and histoplasmosis) was raised, and an incisional biopsy of the oral lesion was performed. Histopathologic sections stained with hematoxylin and eosin (H&E) revealed epithelial hyperplasia and intense poorly defined granulomatous chronic inflammation with rare giant cells in the lamina propria, without signs of necrosis (Fig. 2a, b). Ziehl–Neelsen staining (×400) showed numerous acid-fast bacilli arranged in globi (Fig. 2c). The qPCR test confirms the presence of the Mycobacterium leprae DNA in this sample.

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