standard AFB and Fite stains . In contrast , lepromatous leprosy is characterized by a poor cell-mediated immune response . It typically presents as innumerable macules , plaques , and nodules , often having slightly diminished or normal sensation , with symmetric peripheral nerve involvement . The risk of type 2 lepra reaction is significantly increased . Histopathology shows disorganized aggregates of foamy histiocytes on H & E stain and numerous
6 , 13 , 14
AFB on standard AFB and Fite stains . While our patient was clinically found to have some features suggestive of lepromatous leprosy , the histopathology with well-organized granulomas throughout the dermis and the scant AFB on standard AFB and Fite stains suggest the diagnosis of tuberculoid leprosy . Additionally , our patient responded remarkably well to twodrug antimicrobial therapy directed at the tuberculoid subtype . It is possible that the discrepant clinical and histological subtypes are a feature of zoonotic leprosy .
CONCLUSION
Leprosy is an underrecognized and underdiagnosed disease that has emerged in southern US as a zoonosis associated with nine-banded armadillos . In parts of US where leprosy is exceedingly uncommon , such as WV , diagnosis may be delayed if clinicians are not considering it or asking appropriate historical questions about potential exposure . Awareness of zoonotic leprosy associated with nine-banded armadillos in the southern US is important for prompt diagnosis and treatment to minimize disability .
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