Hansen’s disease- A Diagnostic Dilemma

Shaminder Singh Dhillon, Tejinder Kaur


Hansen’s disease is a chronic granulomatous disease caused by Mycobacterium leprae. It manifests as variety of forms depending upon the immune status of the patient.1,2 The lesions may mimic various diseases most common being cutaneous tuberculosis, subcutaneous mycosis and sarcoidosis. The neurological examination and microscopy serve as diagnostic skills in leprosy. Lepra bacilli are acid fast with 5% sulphuric acid while tubercular bacilli may resist decolourisation with 20% concentration. In this case report we have described a patient of lepromatous leprosy in whom the bacteria obtained on slit skin smears resisted decolourisation with 20% sulphuric acid in contrast to the usual 5% concentration. Since the staining patterns were consistent with tubercular bacteria, this lead to a diagnostic confusion. Further investigations were adopted which included histopathological examination and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) for tubercular bacilli. Final diagnosis was made upon the histopathological examination and negative CBNAAT.



Mycobacteria leprae; acid fast bacilli; Staining technique

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