Prakash B, Anoosha P, Singh S
Indian J Lepr. 2015 Apr-Jun;87(2):85-9.
A circumscribed sclerotic plaque of morphea can sometimes be mistaken for tuberculoid leprosy and vice versa can also happen. However, the co-existence of a patch of morphea mimicking as Leprosy patch in an underlying case of neuriticleprosy, can be very misleading. We present a case with glove and stocking anaesthesia and peripheral nerve enlargement with a single large hypopigmented, non-anaesthetic macule on trunk, clinically diagnosed as Hansen's disease (Borderline Tuberculoid - BT). Slit skin smears proved to be negative for AFB and histopathology of the skin lesion was consistent with morphea, which lead us to do a nerve biopsy. Sural nerve biopsy proved it to be Hansen's neuritis with occasional bacilli. The patient was started on MDT-MB and followed up. This is a rare case of co-existing morphea with Hansen's disease. It would have been easily misclassified if we had presumed the cutaneous lesion to be a case of Hansen's (BT) patch and not done a cutaneous nerve biopsy which led to diagnosis of multibacillary leprosy.
局限性硬斑病的硬化斑块有时会被误诊为结核样型麻风，反之亦然。然而，在潜在的神经炎型麻风病例中，出现一片类似麻风斑块的硬斑病，可能会极具误导性。我们报告一例病例，患者有手套和袜套样感觉缺失以及周围神经粗大，躯干有一个单一的大的色素减退、无感觉异常的斑疹，临床诊断为汉森病（界线类偏结核样型 - BT）。皮肤涂片抗酸杆菌检查结果为阴性，皮肤病变的组织病理学与硬斑病一致，这促使我们进行神经活检。腓肠神经活检证实为汉森神经炎，偶见杆菌。患者开始接受多菌型麻风联合化疗并进行随访。这是一例硬斑病与汉森病共存的罕见病例。如果我们假定皮肤病变为汉森病（BT）斑块而未进行皮肤神经活检，就很容易误诊，而皮肤神经活检最终确诊为多菌型麻风。
