Track: Case Reports

Topic: Infectious Diseases

Abstract:

This study describes a 58-year-old Chinese male diagnosed with lepromatous leprosy complicated by with lucio phenomenon who is positive for antiphospholipid antibodies including anticardiolipin and anti-β2GPI. When admission, he presented with skin necrosis and extensive irregular ulcerations on the extremities attributed to numerous painless hemorrhagic bullae, accompanied by a fever of 38.8℃. Over the past 5 years, he gradually developed scattered nodules, progressive facial skin thickening and hair loss all over the body, with persistent bilateral limbs paresthesia. Three skin parts biopsies from right thickened face, ulcerated lower leg and knee were conducted. Partial tissue together with secretion of the ulcer were smeared to microscopic observation, a part was sent to metagenomic next-generation sequencing (mNGS) to identify possible pathogenic microorganisms, the rest were sent to histopathology. The smear gram staining under the microscope found a large number of uncolored "X", "Y" or bundled rod-shaped ghost-like bacilli shadows which are positive for further acid-fast staining. Histopathology from different parts revealed varying degrees of moderate lymphocytes infiltration around the dermal small vessels and in the subcutaneous fat lobules, with formation of lamellar epithelioid cell granuloma and aggregation of foamy cells. AFS also be conducted and identified numerous acid-fast bacilli in the subcutis, whereas no positive findings were noticed by periodic acid-silver metheramine and periodic acid-Schiff staining. Subsequently, mNGS confirmed the positive result of Mycobacterium leprae.

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Xie Yao, MD