How accurately do clinical diagnosis correlate with biopsy findings in leprosy?

Singh Akhil Kumar, Singh Ranjana, Singh Savitri, Grover Sanjiv

Abstract


Objective To document the clinical profile of leprosy patients and to determine concordance between clinical and histopathological diagnosis using Ridley and Jopling classification.

 

Methods 58 clinically and histological confirmed cases of leprosy ranging in age from 7-70 years who attended dermatology outpatient department (OPD) in Saraswathi Institute of Medical Sciences were included in the study. Slit-skin smear examination was performed in all cases. Histopathological investigations were carried out in all cases to confirm the diagnosis and to classify the cases.

 

Results A total of 58 clinically diagnosed cases of leprosy comprised the study material. Out of them, 42 (72.4%) were males and 16 (27.6%)females with male to female ratio of 2.6:1. The highest number of cases was in age group 20-29 years with 22 (37.9%) cases. 10 (17.2%) cases were multibacillary and 48 (82.8%) cases were paucibacillary. The most common site of biopsy was from lower extremities in 24 (41.4%) cases. Clinically, maximum number of patients was borderline tuberculoid (BT) type with 22 (37.9%) cases, followed by tuberculoid leprosy (TT) in 14 (24.1%) cases. Lepromatous leprosy (LL) was confirmed in 3 (5.2%) cases. Most common clinical presentation was altered sensation in 57 (98.3%) cases, skin plaques in 46 (79.3%) cases and nerve involvement was noted in 36 (62.1%) cases. Maximum clinicopathological correlation was noted in both poles i.e. LL with 3 (100%) cases and TT with 12 (85.7%) cases and maximum disparity was noted in borderline lepromatous leprosy (BL) in 3 (60%) cases. Overall concordance between clinical and histopathological diagnosis observed in our study was 46 (79.3%) cases.

 

Conclusion Leprosy continues to remain a public health problem. Clinical-histopathological discordance leading to inadequate treatment could be contributory. Our study revealed a 20.7% rate of discordance. Early assessment and adequate management is essential for reducing the discordance rate.

 


Keywords


Leprosy, clinicopathological correlation, clinical presentations, Ridley and Jopling classification

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References


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