Palmoplantar, Genital and Lip involvement in a de novo case of Histoid leprosy

Histoid leprosy is a rare expression of mostly lepromatous leprosy, usually arising due to drug-resistant lepra bacilli in patients on long-term dapsone monotherapy or taking irregular and/or inadequate multibacillary multidrug therapy. De novo cases are also being reported. Although its clinical presentation is characteristic, lesions may not always be classical and on rare occasions, it may also involve some atypical sites. Here we are reporting a unique de novo case of histoid leprosy in a 24-year old male presenting with disseminated classical as well as uncommon cutaneous lesions which were also present on palms, soles, upper lip, penile shaft and scrotum. On slit-skin smear and histopathologic evaluation, lesions present over these atypical sites were confirmed to be of histoid variant of lepromatous leprosy. To the best of our knowledge, not a single case of histoid leprosy was reported previously with such a clinical presentation.