Lebbra lepromatosa.

Leprosy is a chronic granulomatous infection primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, an acid-fast obligate intracellular parasite with low virulence and pathogenicity. The host cell-mediated immunity specific for M. leprae determines the development and the clinico-pathological features of the disease. Lepromatous leprosy is the most severe multibacillary type that manifests in anergic subjects. The Authors describe a 26-year-old Filipino man immigrated in Italy since one year who presented with asymptomatic, poorly defined papules, nodules and hypopigmented macules. Lesions were disseminated, more prominent on the face and trunk, with a bilateral and symmetrical distribution. Histological examination of a nodule revealed a dense dermal infiltrate of foamy macrophages and rare lymphocytes. Zihel-Nielsen stain showed acid-fast bacilli in the cytoplasm of the macrophages and in the dermal nerves, confirming the diagnosis of lepromatus leprosy. Microbiologic findings were compatible with a multibacillary disease. A multidrug therapy with rifampicyn (600 mg monthly), dapsone (100 mg daily) and clofazimin (300 mg monthly and 100 mg daily) resulted in marked improvement of the clinical appearance and microbiological findings after three months.