02057nas a2200229   4500000000100000008004100001260001200042653002600054653002200080653003700102653003000139100001200169700001200181700001200193700001400205245009600219856007700315300001200392490000700404520140200411022001401813       2022                            d  c01/202210aCentrofacial eruption10aFoamy macrophages10alocalized multibacillary leprosy10apolymerase chain reaction1 aSahni K1 aYadav D1 aAhuja R1 aAgarwal S00aSymmetrical Centrofacial Erythematous Plaques and Papules: A Clinicopathological Challenge.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8809145/pdf/IDOJ-13-102.pdf  a102-1040 v133 a<p>Facial papular eruptions remain a diagnostic dilemma for the dermatologist with a wide range of inflammatory and infectious conditions manifesting in this manner. Here, we present a case of a 29-year-old, otherwise healthy man from North India with asymptomatic well-defined normoaesthetic symmetrical papules and plaques over the upper and mid-face of 3 months duration. Skin biopsy showed perivascular and periappendageal well-defined collections of foamy macrophages and epithelioid cells in superficial and deep dermis, characteristic of borderline lepromatous leprosy. Though acid-fast stain for lepra bacilli was negative both on lesional biopsy specimen and lesional and ear lobe slit skin smear, a 16s ribosomal ribonucleic acid (16s-r-RNA) polymerase chain reaction on skin biopsy specimen was found to be positive for lepra bacilli. A final diagnosis of borderline lepromatous leprosy in type I reaction was made and the patient received World Health Organization (WHO) multibacillary (MB) multidrug therapy along with oral steroids. This case highlights the unusual localized involvement in a case of MB leprosy lacking all the three cardinal features of leprosy, i.e. sensory loss, peripheral nerve involvement, and acid-fast bacilli positivity on biopsy or slit skin smear but diagnosed on the basis of characteristic histology and positive polymerase chain reaction results.</p>
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