# An unusual presentation in relapse case of histoid leprosy

## TL;DR

This paper presents a rare case of histoid leprosy relapse with an unusual umbilicated skin lesion despite adequate treatment.

## Contribution

The novelty lies in documenting a relapse case with an atypical presentation after proper multidrug therapy.

## Key findings

- Histoid leprosy can relapse even after 12 months of multibacillary multidrug therapy.
- An umbilicated lesion was observed, which is an unusual presentation in histoid leprosy.
- The high lepra bacilli load in such cases complicates diagnosis and treatment.

## Abstract

Histoid leprosy (HL) is a very rare and highly infectious variant of lepromatous leprosy, presenting as skin-coloured, succulent nodules and plaques on apparently healthy skin. It is histologically characterized by a dense bundle of histiocytes arranged in storiform manner. Usually, it occurs in patients with leprosy who relapse after dapsone monotherapy or inadequate antileprotic treatment; it can even arise de novo. We present a case of umbilicated presentation in a patient with a case of relapse HL, even after adequate treatment with multibacillary multidrug therapy for 12 months. Although rare, the higher load of lepra bacilli in these cases makes it a matter of concern, and challenging for leprologists to make early diagnosis and treatment.

Relapse and unusual lesions in histoid leprosy.