Clinical and histopathological study of leprosy cases: Importance of biopsy in accurate subtyping of the spectrum of Hansen’s disease

Abstract : Introduction: Leprosy elicits spectrum of clinical, immunological and histological features. It is classified into 5 types according to Ridley and Jopling classification. . Proper diagnosis, subtyping and treatment play the main role in decreasing leprosy case load. Histopathological examination of skin and nerve lesions is the gold standard for confirmation of clinically suspected cases and classification. Aim of the study: Present study was conducted to study various types of leprosy cases in our population and its clinico-pathological correlation. Materials and method: A three year retrospective study was conducted in which a total 28 clinically diagnosed cases of leprosy were included. Detailed clinical presentations and spectrum of cases were recorded. Skin biopsies from the lesions were stained with Hematoxylin-Eosin stain for histomorphological study and Fite Farraco stain for detection of acid fast bacilli. Results: Out of total 28 cases, 16 cases were of male and 12 cases were female (1.3:1). Average age of patients was 38.9 years. Most common presentation found was asymptomatic plaque (29.6%) followed by nodules(25.9%) , hypopigmented patch (22.4%), ulcer(7.4%) , erythematous plaque (7.4%) and mixed presentation in 7.4% cases. Clinically most common type of leprosy was Borderline Tuberculoid (BT) while histologically Borderline Tuberculoid(BT), Lepromatous Leprosy(LL) and Indeterminate Leprosy(IL) each comprised of 18.5% cases. Correct clinical subtyping was done in 39% cases with maximum correlation in Histioid leprosy(100%) followed by Type 1 lepra reaction (75%). Conclusion: The spectrum of leprosy shows considerable overlap. Therefore , both clinical and histological characteristics with staining for lepra bacilli is the best approach to arrive at a correct diagnosis of these cases.