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Sporotrichoid Hansen’s disease with Hypereosinophilic Syndrome: A Clinicopathological Challenge

Shreya K*, Mukesh K Sahni, Hemlata Panwar, Richa Rokde, Dinesh P Asati

The sporotrichoid distribution of lesions has been described in sporotrichosis, lupus vulgaris, atypical mycobacteria, chromoblastomycosis, nocardia, cat-scratch disease. Apart from these infectious diseases some other conditions like melanoma, squamous cell carcinoma, B cell lymphoma and T cell lymphoma, epithelioid sarcoma, and peripheral nerve sheath tumor had also showed sporotrichoid spread. A 45 year old otherwise healthy male presented with mild painful skin colored to erythematous plaque, initially started over the left dorsa of the ankle, later new plaque appeared to involve the left leg and thigh linearly with an increase in thickness and size of plaque over a period of 4 months. On examination typical sporotrichoid distribution of three well defined, minimally tender edematous, indurated, skin colored to an erythematous plaque with central clearing in large plaque with overlying fine white collarette, non-adherent scale with no sinus, scarring, verrucosity, pustules over left ankle. Based on history and examination differentials of lymphocutaneous sporotrichosis, sporotrichoid lupus vulgaris, wells syndrome, Borderline Tuberculoid (BT) Hansen with resolving type 1 reaction were kept. Biopsy from the erythematous plaque reveals oblong well-defined granuloma composed of epithelioid cells, dense eosinophils. Evaluation for hypereosinophilia yielded no results (stool for ova cyst, chest x-ray, cardiac echo, and serum Immunoglobulin E (IgE) were normal). Though acid-fast stain for lepra bacilli was negative, a final diagnosis of borderline tuberculoid Hansen with resolving type 1 reaction with hypereosinophilic syndrome was made. Hansen’s disease presents with a various morphological spectrum ranging from hypopigmented macule, erythematous plaque, nodule, diffuse infiltration, ulceration, shiny dome-shaped papules and necrotic plaques. Sporotrichoid distribution has not yet been described. Till date, only single case report noted the association of hansen and hypereosinophilic syndrome, this might be any association or mere coincidence.