This young man presented with slowly progressive patches and plaques over his face, trunk and extremities. These were associated with dysesthesia. Clinical considerations included infections as well as sarcoidosis. Biopsy confirmed the diagnosis of leprosy. This is a rare case of histoid leprosy, where nodules develop on otherwise normal skin. The histology supports this with a nodule of histiocytes and numerous organisms. The significance of histoid leprosy is unclear. This patient traveled to India several decades ago, but denies any interval exposure. This interval is at the upper limits reported for leprosy.
There are zones with a necrotic appearance, consisting of sheets of histiocytes with a granular quaity to the cytoplasm. A mixed infiltrate cuffs these histiocytic zones.