An unusual ocular presentation of histoid leprosy

Leprosy is a chronic granulomatous infection caused by mycobacterium leprae, mainly affecting the skin and peripheral nerve. Histoid type of leprosy, which is considered as an extremely rare variant of lepromatous leprosy. We report a case of a 50/year old male presented to our institute with chief complain of conjunctival swelling in both eyes, encroaching over cornea and involving limbus and sclera, associated with painless blurring of vision. An incisional biopsy of the right eye was performed under local anesthesia. Histopathology of right eye biopsy revealed spindle shaped cells having bland looking nuclei and variable amount of cytoplasm which was suggestive of histoid leprosy. A dermatology consultation was sought and patient was diagnosed to have leprosy. Consequent to which he was started on MBALD (multibacillary anti leprosy drug), and showed improvement in patient`s visual acuity as well as regression of right eye swelling and disappearance of left eye swelling.

A Rare Infection Factor in a Patient with Multiple Nodules During The COVID-19 Pandemic Period: Actinomycosis Odontoliticus

Pulmonary actinomycosis has been reported to account for 15% of all cases of actinomycosis, and pulmonary Actinomyces odontolyticus is particularly rare. Actinomycosis is a chronic granulomatous infection that often occurs in immunocompromised conditions, but it can also affect healthy people.Here, we present a case in which we diagnosed an immunocompetent 33-year-old female patient with bronchoalveolar lavage (BAL) by bronchoscopy, which is characterized by nodules with ground glass density in bilateral lung caused by A. odontolyticus due to a dental abscess. Bilateral nodular infiltrates made us think of metastatic lung disease; We assessed the patıent in terms of COVID-19 pneumonıa as we are in the perıod of pandemia.

Raspberry-like tumor on the skin – A rare entity

Rhinosporidiosis is a chronic granulomatous infection, caused by Rhinosporidium seeberi, which frequently affects the nasal cavity and nasopharynx. Cutaneous rhinosporidiosis is rare and probably underreported. We report a case of cutaneous rhinosporidiosis in association with recurrent nasopharyngeal rhinosporidiosis in a 68-year-old male patient.

Leprosy

Chapter 97 reviews leprosy (Hansen disease), which is a chronic granulomatous infection caused by the obligate intracellular bacillus, Mycobacterium leprae. The disease is still endemic in various regions of the world with 70% of cases in India, Myanmar, and Nepal. Skin and peripheral nerves are primarily affected. Nerve involvement results in loss of sensory and motor function, which may lead to frequent trauma and amputation. Nerve abscesses may occur in various forms of leprosy because of caseation of nerve fasciculi. The ulnar nerve is most commonly involved. Ulcers, osteomyelitis, periostitis, and other neuropathic changes in the bones of the hands and feet are the result of prolonged anesthetic changes seen in leprosy patients. Radiography is the initial imaging technique for bone lesions. US and MRI are used in the evaluation of nerve involvement.

The missing grains in Madura foot: imaging to the rescue

<p class="abstract">Mycetoma or Madura foot is a chronic localized granulomatous infection caused by varied species of fungi or actinomycetes clinically diagnosed by active discharging sinuses containing ‘grains’. In atypical presentations or patients unwilling for invasive investigations, imaging essentially plays a key role in diagnosis and helps to differentiate actinomycetoma from eumycetoma. Here we present such an atypical case of unilateral foot swelling without sinuses–cryptic mycetoma. This 69 year old male from Kerala had a swelling over the left foot following trauma initially painless. An x-ray taken showed normal underlying bones with mild soft tissue swelling. To evaluate further USG was taken which showed fine hyperechoiec foci settled at the bottom of cavities highly suggestive of mycetoma. For confirmation USG guided biopsy was taken but was inconclusive. As patient was not willing for repeat biopsy, we advised non invasive MRI that revealed classical ‘Dot In Circle’ sign specific for mycetoma. The distinction that makes the case stand out is its absence of classical picture of discharging sinuses and the fact that imaging rather than histopathology helped confirm the diagnosis in mycetoma.</p>

“Madura Head”—A Rare Case of Craniocerebral Maduromycosis

As maduromycosis is mostly confined to lower extremities. It was rightly named as “Madura foot” by John Gill in 1842, after the name of Madurai district, in Tamil Nadu state of India. Mycetoma is a chronic granulomatous infection mostly caused by a true fungus, Madurella mycetomatis (Eumycotic mycetoma). Craniocerebral involvement by eumycotic mycetoma is rare in world literature and confined to few case reports only. Here we present an interesting case of craniocerebral maduromycosis presenting with focal seizure, hemiparesis, and multiple discharging sinuses all over the scalp. The patient was diagnosed by histopathologic biopsy and managed conservatively with antifungal medications in view of widespread involvement of the scalp, not amenable to surgery.