Introduction: Hansen’s disease (HD) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system caused by Mycobacterium leprae. The incubation period varies from months to more than 30 years. The tuberculoid form of HD usually presents with a single hypoesthetic patch and skin biopsy shows epithelioid granulomas with absence of bacilli on Fite-Faraco stain. In contradistinction, lepromatous leprosy usually presents with numerous papules, plaques and nodules with induration of the ears and nose. Biopsy shows foamy granulomas with presence of acid-fast bacilli on Fite-Faraco stain. Case summary: We present a case of a 13-year old female who presented with a 3-year history of a single hypoesthetic patch on the left knee. The initial clinical diagnosis was tuberculoid leprosy. However, histopathology revealed a Grenz zone, and a nodular granulomatous infiltrate consisting of epitheloid and foamy histiocytes with scattered lymphocytes. Fite-Faraco stain showed a bacillary index (BI) of 3+. Slit-skin smear revealed a BI of 4+. She was then started on multidrug therapy. Conclusion This case highlights the importance of slit-skin smear and biopsy as routine procedures in all new cases of suspected HD. These procedures will help differentiate multibacillary from paucibacillary forms of the disease which will influence decisions for treatment and prognostication. This case emphasizes that lepromatous leprosy may present with single lesions and may be misdiagnosed as paucibacillary leprosy if skin-slit smear and biopsy have not been done. This case further suggests that there are factors yet undetermined which play significant roles in determining the host response to M. leprae which are believed to influence morphology, configuration, number and distribution of skin lesions.
Leprosy ; Leprosy, Multibacillary

Background: Superficial pyoderma is an infection most commonly caused by Staphyloccoccus aureus. The drug of choice is 2% mupirocin cream. However, high cost and emerging drug resistance affect compliance and overall cure. Tinospora rumphii has demonstrated antibacterial activity in vivo rendering it a potential cost-effective alternative treatment. Objectives: To determine the safety and efficacy of 25% T. rumphii cream versus 2% mupirocin cream in the treatment of superficial pyodermas caused by S. aureus. Methods: A randomized, double-blind, controlled study of 60 patients with superficial pyodermas caused by S aureus, aged 18-60, were given either 25% T. rumphii or 2% mupirocin cream for two weeks. Bactericidal activity, erythema, edema, induration and size of lesion were evaluated at baseline, days 3, 7, and 14. Participants Global Assessment (PGA) score and adverse events were noted. Statistical analysis was done using Mann-Whitney U and Pearson Chi square test. RESULTS: Fifty-one subjects (85%) completed the trial. There were no statistically significant differences between the two treatment groups for bactericial activity against Staphylococcus aureus (p=0.687) at day 14, for erythema (p=0.923, 0.5335, 0.3726, 0.6949), edema (p=0.0972, 0.5967, 0.2052, 0.2783), induration (p=0.0855, 0.3113, 0.281, 0.3161), and size of lesions (p=0.7262, 0.169, 0.15, 0.3988) at baseline, days 3, 7 and 14. There was no significant difference in PGA score (p=0.3086, 0.3483, 0.2234) at Days 3, 7 and 14 in both groups. No adverse events were noted. Conclusion Twenty five percent T. rumphii cream is equally safe and effective as 2% mupirocin cream for treatment of superficial pyodermas caused by S. aureus.
Mupirocin ; Staphylococcus aureus