Tuberculoid Leprosy


Henry Foong FRCP, Ipoh, Malaysia

on April 7, 2002

A 72-year-old Chinese woman presented with an asymptomatic plaque on her left upper back for more than 10 years. The lesion gradually increased in size. She was otherwise well. There was no significant past history. It is strange that a huge plaque of this size was left untreated for several years.

Examination showed a 10 by 8 cm asymmetrical annular hypopigmented plaque on the left scapular area of her back with a raised erythematous margin. The edge of the margin appeared somewhat papular. Sensation to temperature and pin prick were marginally diminished. Peripheral nerves were not thickened

There was no history of contact with Hansen's disease.

A biopsy of the lesion was done. Representative sections of the biopsy are shown below.
CXR was normal. VDRL/TPHA was non reactive.

This patient is being presented for interest. We will solicit opinions from dermatologists from Cuba, Hawaii and India and will let you know their comments in our subsequent letter. In Malaysia, Hansen's disease are managed predominantly by dermatologists from the public sector for surveillance purposes. In the mainland USA leprosy is very rare except in immigrants from SE Asia and a small endemic area in Southwestern Louisiana and East Texas.

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