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Dermatology

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Leprosy

Question
7 out of 28
 

Maximum suppression of cell-mediated immunity occurs in:



A Indeterminate leprosy
B Tuberculoid leprosy

C Lepromatous leprosy
D Borderline leprosy

Ans. C
Lepromatous leprosy

1). In lepromatous "leprosy there -is extensive cutaneous involvement and is roughly bilaterally symmetric across the midline of the patient. Individual skin lesions are variable and can include macules, nodules, plaques, or papules. The borders of the lesions are ill defined, and the centers of raised lesions are indurated and convex.

2). There is diffuse infiltration of the dermis between discrete lesions, and apparently normal skin usually contains bacilli which are demonstrable by staining.

3). The sites of preference are the face (cheeks, nose, and brows), ears, wrists, elbows, buttocks, and knees. Loss of the lateral portions of the eyebrows (madarosis) is common and later on the skin of the face and forehead becomes thickened and corrugated (leonine facies), and the earlobes become pendulous.

4). Nasal "stuffiness," epistaxis, and obstructed breathing are common early symptoms. Complete nasal obstruction, laryngitis, and hoarseness may also develop.

5). Septal perforation and nasal collapse leads to saddlenose and invasion of the anterior portion of the eye can result in keratitis and iridocyclitis. Painless inguinal and axillary lymphadenopathy occurs. In men, infiltration and scarring of the testes lead to sterility. Gynecomastia is common.

6). Involvement of the major nerve trunks is less prominent in the lepromatous than in the tuberculoid form, but diffuse hypesthesia involving the peripheral portions of the extremities is common in advanced disease. Pathologic studies demonstrate that the peripheral nerves are heavily infected but often better preserved than in the tuberculoid form.

7). Histological examination reveals a diffuse granulomatous reaction with macrophages, large foam (Virchow or lepra) cells, and many intracellular bacilli, frequently in spheroidal masses (globi) but epithelioid cells and giant cells are not found.

*Loss of eyelashes or eyebrows is known as madarosis.

Leprosy Flashcard List

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