Difficult diagnosis and challenging treatment – a report on leprosy.

Histoid leprosy is an unusual variant of lepromatous leprosy posing difficulties for diagnosis as well as treatment even to the experts. We report a case of a 73 year old male from the hilly region of Nepal, who presented with multiple asymptomatic scrotal nodules for 3 months. Though clinical diagnoses were pilomatricoma and steatocystoma multiplex; histopathological examination was consistent with that of histoid leprosy. After 10 months, he had unusual Type 2 lepra reaction with constitutional symptoms, perichondritis, epididymo-orchitis but without erythema nodosum leprosum. Two years later, his three family members were also affected with leprosy. Hence, this case is reported to highlight the diagnostic dilemma, complicated disease course and infectivity of histoid leprosy.