What is this odd abdominal rash?
33 year old Spanish speaking Mexican male with four year history of these annular, scaling, copper-violaceous patches and plaques appearing on the right lower quadrant. He moved to U.S. (Washington state) from Colima, (Southwestern) Mexico five years ago. He reports that while in Colima, armadillo was the cheapest meat around and he enjoyed eating it.
The patches were also anesthetic.
What is your diagnosis?
Leprosy, or Hansen disease, is a chronic infection of slow onset caused the by the acid-fast bacillus Mycobacterium leprae, whose medical sequelae area primarily determined by the unique tropism of the causative organism, among bacteria, for invasion and consequent pathology of the peripheral nervous and the host's specific immunologic response. Mycobacterium leprae invades the cooler tissues of the body, namely, the skin, peripheral nerves, upper respiratory tract, anterior chamber of the eyes, and testes, resulting in clinical signs and symptoms that are largely confined to these tissues. Depending on the host's cellular immunity, the disease may be benign or malignant, with its course further being complicated by intercurrent immunomediated reactional states. Because antimicrobial therapy can arrest and even at times cure the disease, early diagnosis and therapy are critical in preventing severe debilitating deformity.
The incidence of leprosy is increasing, especially in Mexico and Central America. Complicating matters, it tends to be spread through the ingestion of undercooked armadillo meat, as is the case with this interesting patient.
Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology
References below: Pocket Guide to Cutaneous Medicine and Surgery by Dover, Arndt, LeBoit, Robinson, and Wintroub, page 355-361
For additional information on leprosy and its spread via the ingestion of armadillo meat, please see the reference below.
I would like to thank Dr. Adam Hoverman for this interesting photographic case of the month.