array:25 [
  "pii" => "S1578219021000238"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2021.01.019"
  "estado" => "S300"
  "fechaPublicacion" => "2021-03-01"
  "aid" => "2466"
  "copyright" => "AEDV"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2021;112:280-1"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S0001731020303367"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2019.07.011"
      "estado" => "S300"
      "fechaPublicacion" => "2021-03-01"
      "aid" => "2466"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2021;112:280-1"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta cient&#237;fico-cl&#237;nica</span>"
        "titulo" => "Lepra histioide&#44; un enemigo a&#250;n no erradicado"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "280"
            "paginaFinal" => "281"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Histoid Leprosy&#58; An Enemy Not Yet Eradicated"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 730
                "Ancho" => 905
                "Tamanyo" => 117149
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Manifestaciones cl&#237;nicas&#46; En extremidades superiores&#58; p&#225;pulas y n&#243;dulos eucr&#243;micos&#44; aspecto infiltrado&#44; algunos ulcerados&#44; otros con costra central&#46; En extremidades inferiores&#58; p&#225;pulas que confluyen y forman placas eritemato-marron&#225;ceas&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "N&#46; Calvache, D&#46;A&#46; Arias, V&#46;M&#46; Delgado"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Calvache"
              ]
              1 => array:2 [
                "nombre" => "D&#46;A&#46;"
                "apellidos" => "Arias"
              ]
              2 => array:2 [
                "nombre" => "V&#46;M&#46;"
                "apellidos" => "Delgado"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219021000238"
          "doi" => "10.1016/j.adengl.2021.01.019"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000238?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020303367?idApp=UINPBA000044"
      "url" => "/00017310/0000011200000003/v1_202103020647/S0001731020303367/v1_202103020647/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S1578219021000202"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2021.01.016"
    "estado" => "S300"
    "fechaPublicacion" => "2021-03-01"
    "aid" => "2377"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2021;112:282-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Becker Nevus&#58; 4 Cases of a Rare Syndrome"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "282"
          "paginaFinal" => "283"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "S&#237;ndrome del nevo de Becker&#46; Cuatro casos de una rara entidad"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 506
              "Ancho" => 755
              "Tamanyo" => 46686
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented macule on the right scapular region and shoulder&#44; present since birth&#46; The comedones and hair on the macule appeared at puberty&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46;L&#46; Tirelli, A&#46; Label, P&#46;C&#46; Luna, M&#46; Larralde"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "L&#46;L&#46;"
              "apellidos" => "Tirelli"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Label"
            ]
            2 => array:2 [
              "nombre" => "P&#46;C&#46;"
              "apellidos" => "Luna"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Larralde"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731020301745"
        "doi" => "10.1016/j.ad.2019.11.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020301745?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000202?idApp=UINPBA000044"
    "url" => "/15782190/0000011200000003/v1_202103020923/S1578219021000202/v1_202103020923/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S1578219021000159"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2021.01.012"
    "estado" => "S300"
    "fechaPublicacion" => "2021-03-01"
    "aid" => "2506"
    "copyright" => "AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2021;112:277-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Scrotal Erythema&#58; First Sign of a Cutaneous Drug Reaction to Pazopanib"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "277"
          "paginaFinal" => "279"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Eritema escrotal como manifestaci&#243;n inicial de toxicodermia por pazopanib"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1125
              "Ancho" => 1500
              "Tamanyo" => 190261
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical progression&#46; Maculopapular rash on the trunk and upper limbs &#40;A&#44; B&#41;&#46; Annular erythematous&#44; edematous lesions with a more pronounced border and slight scaling &#40;C&#41;&#46; Resolution of lesions on the trunk and limbs within 2 weeks of interruption of pazopanib &#40;D&#44; E&#41; and improvement of inguinal scrotal lesions &#40;F&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Pons Benavent, E&#46; Silva D&#237;az, S&#46; Guill&#233;n Climent, C&#46; Monteagudo Castro"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Pons Benavent"
            ]
            1 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Silva D&#237;az"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Guill&#233;n Climent"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Monteagudo Castro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731020304294"
        "doi" => "10.1016/j.ad.2019.07.014"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731020304294?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000159?idApp=UINPBA000044"
    "url" => "/15782190/0000011200000003/v1_202103020923/S1578219021000159/v1_202103020923/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
    "titulo" => "Histoid Leprosy&#58; An Enemy Not Yet Eradicated"
    "tieneTextoCompleto" => true
    "saludo" => "To the Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "280"
        "paginaFinal" => "281"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "N&#46; Calvache, D&#46;A&#46; Arias, V&#46;M&#46; Delgado"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "N&#46;"
            "apellidos" => "Calvache"
            "email" => array:1 [
              0 => "nataliacalvachernandez@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "D&#46;A&#46;"
            "apellidos" => "Arias"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "V&#46;M&#46;"
            "apellidos" => "Delgado"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Universidad Libre Cali&#44; Cali&#44; Valle del Cauca&#44; Colombia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Dermat&#243;logo&#44; Maestrante en Epidemiolog&#237;a&#44; Docente Programa de Especializaci&#243;n en Dermatolog&#237;a&#44; Universidad Libre Cali&#44; Cali&#44; Valle del Cauca&#44; Colombia"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Dermatopat&#243;logo&#44; Docente Programa de Especializaci&#243;n en Dermatolog&#237;a&#44; Universidad Libre Cali&#44; Cali&#44; Valle del Cauca&#44; Colombia"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Lepra histioide&#44; un enemigo a&#250;n no erradicado"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 730
            "Ancho" => 905
            "Tamanyo" => 117149
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics&#46; On the upper extremities&#58; skin-colored papules and nodules with an infiltrated appearance&#44; some of which are ulcerated and others with a central crust&#46; On the lower extremities&#58; papules coalescing to form brownish-red plaques&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Histoid leprosy is a rare variant of multibacillary leprosy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has unique clinical&#44; histologic&#44; and immunologic characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Most cases occur as a relapse of lepromatous leprosy&#44; whereas de novo cases are rarer&#46; The histoid lesions have a high bacillus content&#44; which favors growth of resistant strains and&#44; therefore&#44; represents a public-health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> We report a patient from a poor social environment with clinical and histopathologic characteristics of de novo histoid leprosy&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 35-year-old homeless man from Cali was evaluated due to lesions located on the extremities and back&#44; which had appeared 6&#8239;months earlier&#46; The skin lesions were accompanied by weight loss&#44; general malaise&#44; and fever that had not been measured&#46; The patient was a drug abuser and reported having been in contact with his stepfather&#44; who had been diagnosed with Hansen disease&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination revealed multiple skin-colored papules and nodules with an infiltrated appearance&#44; some of which were ulcerated&#44; and others had a central hematic crust&#46; The lesions were located on the upper limbs and back&#46; The lower limbs and buttocks presented papules that coalesced to form brownish-red plaques &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Lack of feeling on palpation was found in all the lesions&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests revealed that the patient was negative for HIV and FTA-ABS&#44; and blood count&#44; liver function&#44; and kidney function were normal&#46; Skin biopsies were taken&#46; Histopathology findings revealed nodular dermal aggregates composed of fusiform histoid cells in a storiform pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and 2B&#41;&#46; Fite-Faraco staining revealed abundant acid-fast and alcohol-fast bacilli &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; A diagnosis of histoid leprosy was made&#46; The patient decided to leave the hospital and it was not&#44; therefore&#44; possible to instate treatment&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Histoid leprosy &#40;HL&#41; is a rare variant of lepromatous leprosy&#46; It was first described in 1963 by Wade&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Most reported cases of HL are relapses in patients with multibacillary leprosy or patients receiving inadequate or irregular treatment&#46; De novo cases exist&#44; in which HL develops with no evidence of other types of leprosy&#46; These cases are even more rare&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as in the case of this patient&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The entity usually presents in men between the ages of 30 and 50&#8239;years&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> Mos5t patients are of low socioeconomic status and have a history of contact with leprosy&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> These sociodemographic characteristics concur with those of our patient&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">HL has unique clinical&#44; histologic&#44; and immunologic characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Classical clinical findings are well defined skin-colored or erythematous shiny papules and cutaneous or subcutaneous plaques and nodules arising from normal skin&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The usual location is on the back&#44; buttock&#44; extremities&#44; and face&#46; It rarely involves the ear lobes and&#44; unlike lepromatous leprosy&#44; madarosis is not present&#46; Loss of feeling in the lesions is typical&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Histopathologic findings include epidermic atrophy and a dermis with a Grenz zone and circumscribed collections of fusiform histoid cells distributed in a storiform pattern&#46; Fite-Faraco staining supports the diagnosis by revealing acid-fast and alcohol-fast bacilli&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The findings in our patient agree with those described in the literature&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The pathogenesis of this unusual variant is not fully understood&#46; It is thought to be the result of multiple factors&#44; combining genetic factors&#44; abnormal immune response&#44; and incomplete treatments&#46; A hyperreactive response is thought to exist with increased cellular immunity due to the presence of necrosis and ulceration in some lesions&#44; which is thought to be an effort to combat the <span class="elsevierStyleItalic">Mycobacterium</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This theory may explain the ulceration observed in several of the nodules in our patient&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The histoid lesions contain a high number of bacilli and are therefore reservoirs for resistant strains of infection&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This is a public-health problem&#44; as it makes eradication of the disease difficult&#8212;more so when patients have little access to health care&#44; as in our patient&#44; who was a homeless man and who decided not to undergo treatment&#46; Treatment of HL is that recommended by the World Health Organization &#40;WHO&#41; for multibacillary leprosy&#44; with clofazimine&#44; dapsone&#44; and rifampicin for 12&#8239;months&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Histoid leprosy is a rare variant and is thought to be underdiagnosed&#46; It is important to recognize the atypical forms of Hansen disease in order to make the appropriate diagnosis and prescribe the correct treatment when required&#44; as well as to prevent the physical and psychological damage that patients may suffer&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Case Description"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Discussion"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conclusions"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflicts of Interest"
        ]
        4 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-06-01"
    "fechaAceptado" => "2019-07-13"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Calvache N&#44; Arias DA&#44; Delgado VM&#46; Lepra histioide&#44; un enemigo a&#250;n no erradicado&#46; Actas Dermosifiliogr&#46; 2021&#59;112&#58;280&#8211;281&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 730
            "Ancho" => 905
            "Tamanyo" => 117149
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics&#46; On the upper extremities&#58; skin-colored papules and nodules with an infiltrated appearance&#44; some of which are ulcerated and others with a central crust&#46; On the lower extremities&#58; papules coalescing to form brownish-red plaques&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 908
            "Ancho" => 1305
            "Tamanyo" => 599467
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology&#46; A and B&#44; Dermis with nodules formed by fusiform histiocytes in a storiform pattern &#40;hematoxylin&#8211;eosin&#41;&#46; C&#44; Fite-Faraco staining&#46; Multiple acid-fast and alcohol-fast bacilli&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The histoid variety of lepromatous leprosy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;W&#46; Wade"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Lepr"
                        "fecha" => "1963"
                        "volumen" => "31"
                        "paginaInicial" => "129"
                        "paginaFinal" => "142"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14086699"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histoid leprosy&#46; An ultrastructural observation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Ridley"
                            1 => "D&#46;S&#46; Ridley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Int J Lepr Other Mycobact Dis&#46;"
                        "fecha" => "1980"
                        "volumen" => "48"
                        "numero" => "2"
                        "paginaInicial" => "135"
                        "paginaFinal" => "139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7190551"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histoid leprosy as reservoir of the disease&#59; a challenge to leprosy elimination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Palit"
                            1 => "A&#46;C&#46; Inamadar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lepr Rev"
                        "fecha" => "2007"
                        "volumen" => "78"
                        "paginaInicial" => "47"
                        "paginaFinal" => "49"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17518092"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of histoid leprosy &#40;de novo&#41; in lepromatous &#40;multibacillary&#41; leprosy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46;N&#46; Sehgal"
                            1 => "A&#46; Aggarwal"
                            2 => "G&#46; Srivastava"
                            3 => "N&#46; Sharma"
                            4 => "S&#46; Sharma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2004.02540.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol&#46;"
                        "fecha" => "2005"
                        "volumen" => "44"
                        "paginaInicial" => "576"
                        "paginaFinal" => "578"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15985027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinical and histopathological study of histoid leprosy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;P&#46; Nair"
                            1 => "G&#46;N&#46; Kumar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4632.2012.05753.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "52"
                        "paginaInicial" => "580"
                        "paginaFinal" => "586"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23590373"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histoid&#44; a clinical variant of multibacillary leprosy&#58; report from so-called nonendemic areas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Kalla"
                            1 => "S&#46; Purohit"
                            2 => "M&#46;C&#46; Vyas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Lepr Other Mycobact Dis&#46;"
                        "fecha" => "2000"
                        "volumen" => "68"
                        "paginaInicial" => "267"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11221088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histoid leprosy&#58; a retrospective study of 40 cases from India"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Kaur"
                            1 => "S&#46; Dogra"
                            2 => "D&#46; De"
                            3 => "U&#46;N&#46; Saikia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2008.08899.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Brit J Dermatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "160"
                        "paginaInicial" => "305"
                        "paginaFinal" => "310"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Status of histoid leprosy&#8211;a clinical&#44; bacteriological&#44; histopathological and immunological appraisal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46;N&#46; Sehgal"
                            1 => "G&#46; Srivastava"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1346-8138.1987.tb02993.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol"
                        "fecha" => "1987"
                        "volumen" => "14"
                        "paginaInicial" => "38"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3301948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histoid leprosy&#58; a retrospective clinicopathological study from central Nepal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Mathur"
                            1 => "A&#46; Jha"
                            2 => "R&#46; Joshi"
                            3 => "R&#46; Wagle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.13593"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "56"
                        "paginaInicial" => "664"
                        "paginaFinal" => "668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28321841"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunohistochemistry in histoid leprosy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;J&#46; Kontochristopoulos"
                            1 => "K&#46; Aroni"
                            2 => "D&#46;N&#46; Panteleos"
                            3 => "A&#46;D&#46; Tosca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-4362.1995.tb04396.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "1995"
                        "volumen" => "34"
                        "paginaInicial" => "777"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8543410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000011200000003/v1_202103020923/S1578219021000238/v1_202103020923/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000003/v1_202103020923/S1578219021000238/v1_202103020923/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021000238?idApp=UINPBA000044"
]
Share
Journal Information
Vol. 112. Issue 3.
Pages 280-281 (March 2021)
Visits
6001
Vol. 112. Issue 3.
Pages 280-281 (March 2021)
Case and Research Letters
Open Access
Histoid Leprosy: An Enemy Not Yet Eradicated
Lepra histioide, un enemigo aún no erradicado
Visits
6001
N. Calvachea,
Corresponding author
, D.A. Ariasb, V.M. Delgadoc
a Servicio de Dermatología, Universidad Libre Cali, Cali, Valle del Cauca, Colombia
b Dermatólogo, Maestrante en Epidemiología, Docente Programa de Especialización en Dermatología, Universidad Libre Cali, Cali, Valle del Cauca, Colombia
c Dermatopatólogo, Docente Programa de Especialización en Dermatología, Universidad Libre Cali, Cali, Valle del Cauca, Colombia
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Full Text
To the Editor:

Histoid leprosy is a rare variant of multibacillary leprosy.1 It has unique clinical, histologic, and immunologic characteristics.2 Most cases occur as a relapse of lepromatous leprosy, whereas de novo cases are rarer. The histoid lesions have a high bacillus content, which favors growth of resistant strains and, therefore, represents a public-health problem.3 We report a patient from a poor social environment with clinical and histopathologic characteristics of de novo histoid leprosy.

Case Description

A 35-year-old homeless man from Cali was evaluated due to lesions located on the extremities and back, which had appeared 6 months earlier. The skin lesions were accompanied by weight loss, general malaise, and fever that had not been measured. The patient was a drug abuser and reported having been in contact with his stepfather, who had been diagnosed with Hansen disease.

The physical examination revealed multiple skin-colored papules and nodules with an infiltrated appearance, some of which were ulcerated, and others had a central hematic crust. The lesions were located on the upper limbs and back. The lower limbs and buttocks presented papules that coalesced to form brownish-red plaques (Fig. 1). Lack of feeling on palpation was found in all the lesions.

Figure 1.

Clinical characteristics. On the upper extremities: skin-colored papules and nodules with an infiltrated appearance, some of which are ulcerated and others with a central crust. On the lower extremities: papules coalescing to form brownish-red plaques.

(0.11MB).

Blood tests revealed that the patient was negative for HIV and FTA-ABS, and blood count, liver function, and kidney function were normal. Skin biopsies were taken. Histopathology findings revealed nodular dermal aggregates composed of fusiform histoid cells in a storiform pattern (Fig. 2A and 2B). Fite-Faraco staining revealed abundant acid-fast and alcohol-fast bacilli (Fig. 2C). A diagnosis of histoid leprosy was made. The patient decided to leave the hospital and it was not, therefore, possible to instate treatment.

Figure 2.

Histopathology. A and B, Dermis with nodules formed by fusiform histiocytes in a storiform pattern (hematoxylin–eosin). C, Fite-Faraco staining. Multiple acid-fast and alcohol-fast bacilli.

(0.57MB).
Discussion

Histoid leprosy (HL) is a rare variant of lepromatous leprosy. It was first described in 1963 by Wade.1 Most reported cases of HL are relapses in patients with multibacillary leprosy or patients receiving inadequate or irregular treatment. De novo cases exist, in which HL develops with no evidence of other types of leprosy. These cases are even more rare,4 as in the case of this patient.

The entity usually presents in men between the ages of 30 and 50 years.5–7 Mos5t patients are of low socioeconomic status and have a history of contact with leprosy.7 These sociodemographic characteristics concur with those of our patient.

HL has unique clinical, histologic, and immunologic characteristics.2 Classical clinical findings are well defined skin-colored or erythematous shiny papules and cutaneous or subcutaneous plaques and nodules arising from normal skin.8 The usual location is on the back, buttock, extremities, and face. It rarely involves the ear lobes and, unlike lepromatous leprosy, madarosis is not present. Loss of feeling in the lesions is typical.

Histopathologic findings include epidermic atrophy and a dermis with a Grenz zone and circumscribed collections of fusiform histoid cells distributed in a storiform pattern. Fite-Faraco staining supports the diagnosis by revealing acid-fast and alcohol-fast bacilli.9 The findings in our patient agree with those described in the literature.

The pathogenesis of this unusual variant is not fully understood. It is thought to be the result of multiple factors, combining genetic factors, abnormal immune response, and incomplete treatments. A hyperreactive response is thought to exist with increased cellular immunity due to the presence of necrosis and ulceration in some lesions, which is thought to be an effort to combat the Mycobacterium.10 This theory may explain the ulceration observed in several of the nodules in our patient.

The histoid lesions contain a high number of bacilli and are therefore reservoirs for resistant strains of infection.3 This is a public-health problem, as it makes eradication of the disease difficult—more so when patients have little access to health care, as in our patient, who was a homeless man and who decided not to undergo treatment. Treatment of HL is that recommended by the World Health Organization (WHO) for multibacillary leprosy, with clofazimine, dapsone, and rifampicin for 12 months.

Conclusions

Histoid leprosy is a rare variant and is thought to be underdiagnosed. It is important to recognize the atypical forms of Hansen disease in order to make the appropriate diagnosis and prescribe the correct treatment when required, as well as to prevent the physical and psychological damage that patients may suffer.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
H.W. Wade.
The histoid variety of lepromatous leprosy.
Int J Lepr, 31 (1963), pp. 129-142
[2]
M.J. Ridley, D.S. Ridley.
Histoid leprosy. An ultrastructural observation.
Int J Lepr Other Mycobact Dis., 48 (1980), pp. 135-139
[3]
A. Palit, A.C. Inamadar.
Histoid leprosy as reservoir of the disease; a challenge to leprosy elimination.
Lepr Rev, 78 (2007), pp. 47-49
[4]
V.N. Sehgal, A. Aggarwal, G. Srivastava, N. Sharma, S. Sharma.
Evolution of histoid leprosy (de novo) in lepromatous (multibacillary) leprosy.
Int J Dermatol., 44 (2005), pp. 576-578
[5]
S.P. Nair, G.N. Kumar.
A clinical and histopathological study of histoid leprosy.
Int J Dermatol., 52 (2013), pp. 580-586
[6]
G. Kalla, S. Purohit, M.C. Vyas.
Histoid, a clinical variant of multibacillary leprosy: report from so-called nonendemic areas.
Int J Lepr Other Mycobact Dis., 68 (2000), pp. 267-271
[7]
I. Kaur, S. Dogra, D. De, U.N. Saikia.
Histoid leprosy: a retrospective study of 40 cases from India.
Brit J Dermatol., 160 (2009), pp. 305-310
[8]
V.N. Sehgal, G. Srivastava.
Status of histoid leprosy–a clinical, bacteriological, histopathological and immunological appraisal.
[9]
M. Mathur, A. Jha, R. Joshi, R. Wagle.
Histoid leprosy: a retrospective clinicopathological study from central Nepal.
Int J Dermatol., 56 (2017), pp. 664-668
[10]
G.J. Kontochristopoulos, K. Aroni, D.N. Panteleos, A.D. Tosca.
Immunohistochemistry in histoid leprosy.
Int J Dermatol, 34 (1995), pp. 777-781

Please cite this article as: Calvache N, Arias DA, Delgado VM. Lepra histioide, un enemigo aún no erradicado. Actas Dermosifiliogr. 2021;112:280–281.

Copyright © 2020. AEDV
Download PDF
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?