Hansen’s Disease Presenting as Erythroderma in a Tribal Woman of South Gujarat

The term erythroderma is defined as generalized erythema with scaling, affecting 90% of the skin surface and is considered as a dermatologic emergency. It can precipitate secondary to skin diseases such as psoriasis, atopic or seborrheic eczema, drug-induced, congenital conditions, due to T‐cell lymphoma of the skin or idiopathic and rarely infectious causes. We report a case of a 40-year-old female, who presented to us with complaints of generalized erythema and scaling involving the trunk, face, and extremities along with tightness of skin and generalized swelling. There was also the presence of oral ulceration, and low-grade fever, along with generalized weakness and lethargy which was aggravated over the last few days. Loss of lateral one-third of eyebrows was also noted suggesting atopic cause. With a differential diagnosis of erythroderma due to atopic eczema or other infection, a biopsy was done. Histopathological examination was suggestive of borderline lepromatous Leprosy with type 1 lepra reaction, Fite Faraco stain was also positive showing solid staining bacilli. To confirm neurological examination was done, and it was observed that she had bilaterally symmetrical nerve thickening of all the major peripheral nerves. The slit skin smear from the ear lobe stained positive for M. leprae. Further, on clinicopathological correlation, the diagnosis of borderline lepromatous leprosy with type I reaction (Reversal reaction) was confirmed. In rare sporadic cases, an infectious disease can also precipitate into erythroderma. Thus, in India, especially in endemic zones a high index of suspicion along with proper clinical history, examination, and routine tests like slit-skin smears and biopsy are essential to reach the precise diagnosis of an underlying disorder and therefore crucial to institute the appropriate therapy. Awareness of leprosy with reactions or undergoing therapy with drugs like dapsone as a cause of erythroderma is necessary. The case presented in this report shows simple tests like slit-skin smears for acid-fast bacilli (AFB) alone or in conjunction with histopathology will help establish the diagnosis and also classify the spectrum of the disease.