A 40-year-old man was evaluated for symmetrical hypopigmented macules of 2years duration on the trunk and face. Loss of fine touch was present within the lesions. Loss of lateral half of eyebrows was also seen. Histologic findings confirmed the clinical diagnosis of lepromatous leprosy.
A punch biopsy from a lesion on the back shows atrophic epidermis with an aggregation of foamy macrophages around adnexal structures and nerve twigs. There is very little lymphocytic infiltration. There are no well formed granulomas, and a Grenz zone is present. Fite stain demonstrates many acid fast bacilli in the cytoplasm of foamy macrophages, which confirmed the diagnosis of lepromatous leprosy.Panel A (200X)shows an atrophic epidermis, presence of grenz zone, and foamy macrophages around adnexal structures. Panel B (200X)shows foamy macrophages around nerve bundle. 200x. Panel C (450X)shows foamy macrophages. Panel D (1,000X)shows fite stain with many acid fast bacilli.