Clinicohistological disparity in leprosy

A healthy elderly man presented with localized isolated erythematous tender, anesthetic, oval plaque with little scaling near the medial angle of right eye, of 3 years' duration without any obvious nerve thickening, treated irregularly with WHO MDT for 3 months, clinically simulating BT leprosy with downgrading reversal reaction. Histology showed a BL granuloma with plenty of solid staining AFB within the foamy macrophages. Lepromin test was very weakly positive. The case is discussed in the light of clinicohistological disparity in leprosy cases with review of relevant literatures. A stress is laid on the importance of newer MDT in such cases to prevent drug-resistance, relapse and recurrence.