{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T03:45:09Z","timestamp":1765079109053},"reference-count":7,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2006,2,23]],"date-time":"2006-02-23T00:00:00Z","timestamp":1140652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2006,4]]},"abstract":"A 39\u2010year\u2010old man presented with a chronic nonhealing toe ulcer and multiple skin\u2010colored papules on the back, arms, and knees. From an initial small erosion, the toe lesion ulcerated over a 1.5\u2010year period, while the papules progressed over a 6\u2010month period, first appearing on the back and then spreading to the arms and knees. The past medical and family history were noncontributory. Pertinent findings included the aforementioned well\u2010defined, asymmetric, shiny papules (Fig.\u00a01<\/jats:ext-link>). There were multiple, discrete, erythematous, pedunculated, tumor\u2010like masses of various sizes over the right thigh (Fig.\u00a02<\/jats:ext-link>) and a well\u2010defined 4\u00a0cm\u00a0\u00d7\u00a03\u00a0cm ulcer on the second toe of the left foot, the floor of which was covered by necrotic slough.<\/jats:p>Skin\u2010colored papules of histoid leprosy on the back<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>Pedunculated tumor\u2010like masses on the left thigh<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>There was distal loss of sensation to temperature, touch, and pain. The greater auricular, ulnar, radial cutaneous and common peroneal nerves were thickened bilaterally, but nontender. A clinical diagnosis of histoid leprosy was made. The differential diagnosis for the tumor\u2010like thigh masses included dermatofibroma, neurofibroma, and Kaposi's sarcoma.<\/jats:p>The hemogram, liver\/renal function tests, chest X\u2010ray, and abdominal ultrasound were normal. Human immunodeficiency virus enzyme\u2010linked immunosorbent assay (HIV ELISA) was negative. The ear lobe smear (ELS) for acid\u2010fast bacilli showed a bacterial index (BI) of 6+[>\u00a01000 organisms\/oil immersion field (oif)] and a morphological index (MI) of 50%. The skin\u2010colored papules on the back and the pedunculated masses showed a BI of 5+ (100\u20131000 organisms\/oif) and an MI of 50%. The normal skin showed a BI of 4+ (10\u2013100 organisms\/oif) and an MI of 5%. Biopsy of the papules and pedunculated tumors showed a well\u2010circumscribed area of the dermis packed with many acid\u2010fast organisms and foamy macrophages, consistent with histoid leprosy (Fig.\u00a03<\/jats:ext-link>). Fite\u2013Faraco stain demonstrated cells packed with lepra bacilli.<\/jats:p>Skin biopsy showing foamy macrophages packed with many acid\u2010fast organisms (Fite stain; \u00d7400)<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>A final diagnosis of lepromatous leprosy, histoid variant, was made. Dapsone, clofazimine, rifampicin, and, later, ofloxacin were started.<\/jats:p>","DOI":"10.1111\/j.1365-4632.2006.02669.x","type":"journal-article","created":{"date-parts":[[2006,2,23]],"date-time":"2006-02-23T09:31:17Z","timestamp":1140687077000},"page":"433-434","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Histoid leprosy \u2013 unusual presentation"],"prefix":"10.1111","volume":"45","author":[{"given":"S. Pradeep","family":"Nair","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Prasanna","family":"Moorthy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukumaran","family":"Suprakasan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabeena","family":"Jayapalan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gomathy","family":"Mini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,4,5]]},"reference":[{"key":"e_1_2_2_2_2","first-page":"129","article-title":"Histoid variety of lepromatous leprosy","volume":"31","author":"Wade HW","year":"1963","journal-title":"Int J Lepr"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1346-8138.1987.tb02993.x"},{"key":"e_1_2_2_4_2","first-page":"125","article-title":"Histoid leprosy \u2013 a histopathological reappraisal","volume":"105","author":"Sehgal VN","year":"1987","journal-title":"Acta Leprol"},{"key":"e_1_2_2_5_2","first-page":"580","article-title":"Histoid leprosy","volume":"87","author":"Mansfield RD","year":"1969","journal-title":"Arch Pathol"},{"key":"e_1_2_2_6_2","first-page":"1","article-title":"The histoid leproma, its characteristics and significance","volume":"37","author":"Rodriguez JN","year":"1969","journal-title":"Int J Lepr"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1159\/000248566"},{"key":"e_1_2_2_8_2","first-page":"149","article-title":"Histoid variety of lepromatous leprosy","volume":"40","author":"Desikan KV","year":"1972","journal-title":"Int J Lepr"}],"container-title":["International Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-4632.2006.02669.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1365-4632.2006.02669.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T00:40:33Z","timestamp":1696898433000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-4632.2006.02669.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,4]]},"references-count":7,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2006,4]]}},"alternative-id":["10.1111\/j.1365-4632.2006.02669.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1365-4632.2006.02669.x","archive":["Portico"],"relation":{},"ISSN":["0011-9059","1365-4632"],"issn-type":[{"value":"0011-9059","type":"print"},{"value":"1365-4632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,4]]},"assertion":[{"value":"2006-04-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}