Histoid Leprosy Presenting De Novo: A Rare Variant in the Post-Elimination Era

Abstract

Histoid leprosy is an uncommon variant of lepromatous leprosy, presenting with distinctive clinical and histopathological features which also mimic other entities. We report a case of a 10-year-old male who developed multiple, elevated dome shaped erythematous as well as skin-coloured lesions over bilateral arms, elbows and abdomen for two months, without any history of contact, similar lesions or treatment. The unusual presentation led to a diagnostic dilemma, with initial differentials including sarcoidosis, xanthoma, and dermatofibroma. The absence of non-caseating granulomas and their characteristic histopathological pattern ruled out these conditions. Fite-Faraco staining revealed a heavy bacillary load with cluster (globi) formation, confirming the diagnosis of de novo histoid leprosy. This case highlights the importance of recognizing de novo histoid leprosy even in the absence of prior treatment or contact history, as early diagnosis and appropriate therapy are essential to prevent disease transmission and complications.