Morphea Simulating Paucibacillary Leprosy Clinically and Histopathologically
A 24 yr-old male presented to our dermatology department complaining of hypochromic plaques in his abdomen and neck.\nIn November of 2009, he consulted for a solitary oval hypochromic plaque with reddish-edge and smooth surface in the abdomen with absent of hair inside the plaque [].\nA biopsy was performed in the edge of the lesion under suspicion of paucibacillary leprosy. The result of the biopsy showed perineurovascular lymphocytic infiltration []. A bacilloscopy was performed with negative result.\nThe patient was diagnosed with paucibacillary leprosy and treatment was established.\nThe patient received treatment for five months with rifampicin 600 mg/monthly and dapsone 100 mg/daily without improvement. In the fifth month of treatment the patient developed a satellite lesion with similar characteristics and another plaque with the same morphology in the neck, reason that made him consult again.\nOn physical examination the main lesion was an oval indurated hypochromic plaque with reddish-edge and smooth surface in the abdomen with some hairless areas inside the plaque and no alteration of sensibility. In the upper part of the main lesion there was a smaller hypocromic plaque with lilac-colored edge and no hair inside, did not have alteration of sensibility either; in the neck there was another hypochromic plaque with light erythematous edge and scaly surface with alteration of sensibility.\nA new biopsy from the center of the initial plaque was performed suspecting localized morphea. The result showed subepidermic hyalinized collagen with loss of epidermal rete ridge pattern and some dilated superficial venules in the superficial dermis; there was atrophy of the adnexal structures. In the middle dermis there was a lymphocytic infiltrate with linear arrays between the thickened collagen bundles that enclose some ducts and eccrine glands [].\nThose findings in the histopatological exam confirmed the diagnosis of morphea.