Papillary eccrine adenoma.

A 28-year-old man came to us with a solitary skin colored, mildly tender nodule of 6 months duration on the dorsum of the right hand. On histological examination, multiple dilated ducts without apparent continuity with the surface were found in the dermis. These dilated ducts had branching tubules with eosinophilic amorphous material filling most of the lumina. The peripheral cells of the tubules resembled myoepithelial cells, whereas the luminal border cells were cuboidal or low columnar. Papillary projections arising from the inner cells were seen extending into the lumen. These features were diagnostic of a rare tumor, papillary eccrine adenoma.

Pure neural leprosy presenting with multiple nerve abscesses.

A 22-year-old male student presented to us with patchy sensory loss over the dorsum of right foot of 6 months' duration and swelling over the left index finger of 2 months' duration. Subsequently, a week later, he developed a painful swelling over the left forehead and right leg. On examination, tender soft, fluctuant subcutaneous saccular swellings were seen varying in size from 2x2 cm to 5x5 cm over the left supratrochlear, left radial cutaneous nerve, left digital nerve, right superficial peroneal nerve and left saphenous nerve. The nerves were tender and thickened above and below these cold swellings (cold nerve abscesses). Nerve biopsy of the left radial cutaneous nerve showed granulomatous infiltrate of epithelioid cells, lymphocytes and caseation necrosis of nerve. No bacilli were demonstrated with acid-fast stain. On the basis of the above findings, a diagnosis of pure neuritic leprosy (BT spectrum) in type 1 lepra reaction with multiple nerve abscesses was made. We present this case of pure neuritic leprosy exhibiting multiple nerve abscesses, for its rarity.

A rare variant of erythema nodosum leprosum: a case report.

We report a patient with lepromatous leprosy who developed a rare variant of type-2 lepra reaction, characterized by pustular lesions, on switching from WHO multi drug therapy (MDT) to ofloxacin-aided MDT.

A rare variant of erythema nodosum leprosum: a case report

We report a patient with lepromatous leprosy who developed a rare variant of type-2 lepra reaction, characterized by pustular lesions, on switcching multi drug therapy (MDT) to ofloxacin-aided MDT.

Leg ulcers in active lepromatous leprosy associated with cryoglobulinaemia.

A 40-year-old male agricultural labourer presented with active lepromatous leprosy and painful leg ulcers of 2 months' duration. Biopsy from the ulcer showed nonspecific changes. Raised erythrocyte sedimentation rate and positive rheumatoid factor made us suspect underlying cryoglobulinaemia. Presence of cryoprecipitate in the serum, demonstration of cryoglobulins by serum electrophoresis and raised cryocrit were compatible with cryoglobulinaemia as the cause of atypical leg ulcers in this case. The ulcers healed with bed rest, aspirin and specific anti-leprosy treatment. Though 95% of lepromatous leprosy patients can have cryoglobulinaemia, the presence of atypical ulcers as seen in our patient has not previously been related to the presence of cryoglobulinaemia.

Localized lepromatous leprosy presenting as a painful nodule in a muscle.

Lepromatous leprosy is a generalized disease usually presenting with numerous macules, papules, nodules or plaques involving wide areas of the skin. It is generally believed that in India lepromatous leprosy often originates from the borderline spectrum (Jha et al, 1991). Localized lepromatous or borderline lepromatous disease is a rare variant of multibacillary leprosy (Yoder et al, 1985; Jha et al, 1991; Pfaltzgraff & Ramu, 1994; Vijaikumar et al, 2001). This variant usually presents as a single nodule or a localized area of nodules and papules, while most of the body surface appears normal (Pfaltzgraff & Ramu, 1994; Vijaikumar et al, 2001). Its occurrence in our case as a single painful nodule in the bicep muscle of left forearm was indeed intriguing, such presentation being rarely reported in the literature.

Leg ulcers in active lepromatous leprosy associated with cryoglobulinaemia

A 40-year-old male agricultural labourer presented with active lepromatous leprosy and painful leg ulcers of 2 months' duration. Biopsy from the ulcer showed nonspecific changes. Raised erythrocyte sedimentation rate and positive rheumatoid factor made us suspect underlying cryoglobulinaemia. Presence of cryoprecipitate in the serum, demonstration of cryoglobulins by serum electrophoresis and raised cryocrit were compatible with cryoglobulinaemia as the cause of atypical leg ulcers in this case. The ulcers healed with bed rest, aspirin and specific anti-leprosy treatment. Though 95 per cent of lepromatous leprosy patients can have cryoglobulinaemia, the presence of atypical ulcers as seen in our patient has not previously been related to the presence of cryoglobulinaemia.