Which of the following can lead to infiltration of ear lobules, loss of nails and resorption of distal phalanges?
Ans. B. Lepromatous leprosy. (Ref. Harrison's 18th/pg. 1362)LEPROSYSpecific symptoms vary depending on the type of leprosy.# Tuberculoid leprosy: A rash appears, consisting of one or a few flat, whitish areas. Areas affected by this rash are numb because the bacteria damage the underlying nerves.# Lepromatous leprosy: Many small bumps or larger raised rashes of variable size and shape appear on the skin. There are more areas of numbness than in tuberculoid leprosy, and certain muscle groups may be weak. Much of the skin and many areas of the body, including the kidneys, nose, and testes, may be affected due to heavy bacillary infiltration.# Borderline leprosy: Features of both tuberculoid and lepromatous leprosy are present. Without treatment, borderline leprosy may become less severe and more like the tuberculoid form, or it may worsen and become more like the lepromatous form.Lepromatous leprosy# There are countless disseminated macules and/or skin nodules, with blurred outlines and sometimes joining to form larger plaques.# No tendency to central healing is seen and there is no hypopigmentation, although sometimes a "copper colour" is present. The infiltrated skin nodules do exhibit less or no anaesthesia, but numbness develops in the hands and feet.# The skin infiltration may lead to diffuse skin thickening, chiefly of the ears, lips and forehead.# Infiltration of the mucosa leads to chronic rhinitis with epistaxis, septum perforation and destruction of the nasal cartilages. The tongue is thickened and there may be hoarseness.# The upper incisors become loose and often drop out. There is often loss of the eyebrows (madarosis) and eyelashes. The central portion of the forehead (frontalis muscle) is more affected than the lateral portions. The sensory loss on the forehead can be quite marked (since the skin is relatively cool) but at the hairline, there tends to be an abrupt increase in the sensitivity to pinprick.# Testicular atrophy leads to gynaecomastia. The nerves are not severely thickened, but involvement of the nerves is extensive, generalised, gradual and symmetrical.# The consequences of this loss are evident later in the disease and sensory dysfunction, rather than motor defects, are foremost. Deep tendon reflexes are preserved for a long time, which distinguishes this diseases from many other neuropathies (except amyloidosis).# Vibration sense and position sense remain intact for a long time. With progression of the disease, the motor branches of small nerves are invaded, so that there is distal atrophy, especially in the hands.Clinical Features of TestTT FormLL FormSkin lesionsNumberOne or fewNumerousSensationAbsentNot affectedSurfaceDry or scalyShinyHair growth in lesionsAbsentNot affectedNerve enlargementCutaneous nervesommonNot enlargedLarger peripheral nervesVery rareSymmetrilcally enlargedENL reactionDoes not occurCommonLepromin testStrongly positiveNegativeBacillary index05 or 6Skin histology Granuloma cellEpithelioidFoamy histiocyteLymphocytes++++/-Dermal nervesDestroyedEasily visiblePrognosisGoodPoor
Tuberculoid leprosy
Lepromatous leprosy
Indeterminate leprosy
Any of the above
Bacterial Infection of Skin