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Correspondence: Address to Matthew W. McEwen, MD, University of Tennessee Health Science Center Kaplan-Amonette Department of Dermatology, 930 Madison Avenue, Suite 840, Memphis, TN 38163.
A 77-year-old man with psoriatic arthritis, on methotrexate, presented with asymptomatic skin lesions. He denied altered sensation within the lesions and history of international travel, but he reported previously cleaning out suspected armadillo burrows. Physical examination revealed pink, smooth, annular, and cyclic papules and plaques on the extremities and back (Figures 1 and 2). Histopathology showed clusters of acid-fast staining organisms within foamy histiocytes in the dermis (Supplemental Figure, available online at http://www.mayoclinicproceedings.org). Tissue polymerase chain reaction was positive for Mycobacterium leprae, confirming the diagnosis of Hansen disease. Based on clinical and histopathological findings, the patient was classified as having borderline lepromatous disease. Treatment for multibacillary disease with clofazimine, dapsone, and rifampin was initiated for a planned 24-month course, with near resolution of skin lesions after 6 weeks.
Figure 1Annular and cyclic pink papules and plaques on the thigh.
Hansen disease classically presents with cutaneous and neurologic findings ranging from solitary or few annular plaques with lesional anesthesia to diffuse macules, papules, and skin infiltration with stocking-glove neuropathy.
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