Nonpruritic erythematous plaques
The patient had a history of severe hand eczema. He was also an avid outdoorsman. Might these 2 factors point to the diagnosis?
Diagnosis: Borderline lepromatous leprosy
Based on the exam and the results of the biopsy, we diagnosed borderline lepromatous leprosy. Microscopic findings of the punch biopsy showed lymphohistiocytic infiltrate with granulomatous features and numerous acid-fast bacilli (FIGURE 2).
Leprosy traced to a hunting excursion? On further questioning, the patient revealed a very interesting anecdote regarding how he may have contracted leprosy. He reported that approximately 2 to 3 years before his skin symptoms and numbness began, he went hunting in South Texas with some friends. One of the animals he shot was an armadillo. He processed the armadillo, and he and his friends subsequently cooked and ate the meat. Given his history of chronic hand eczema, he wondered whether he might have contracted the disease through an open wound on his hands.
This was possible, given that there are at least 16 case reports of patients with leprosy (also known as Hansen’s disease) in Louisiana, Mississippi, and Texas in which the patient’s contact with armadillos appeared to be the only potential source of transmission.1 That said, leprosy is still a rare condition in the United States: Only 6518 active cases were registered in 2001.2 Eighty percent of these patients were immigrants or frequent travelers to endemic regions.2
FIGURE 2
Punch biopsy
