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Image 44. An 80
year old male from India, in Canada for 40 years developed a swollen tender right inguinal
lymphnode and at the same time noted an eczematoid rash above his left elbow. Within a
month a lymph node biopsy revealed a mixed granulomatous and polymorphonuclear histology
with huge numbers of AFB in the macrophages seen in this image..What was the
diagnosis?
case from Dr Chris Greenaway |
Image 44. This was lepromatous leprosy, most probably presenting as a type 2 reaction (erythema nodosum leprosum). The Fite stain (the Ziehl-Neelsen stain variant used to stain M. leprae) revealed large numbers of AFB in clusters (globi) in the macrophages, strongly suggestive of leprosy and not tuberculosis. He was HIV negative. PCR of biopsy material, followed by sequencing of the HSP65 gene, gave a product that on BLAST analysis was identical to Mycobacterium leprae sequences.(courtesy of Dr.Makeda Semret, McGill university)