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Hansen Disease: Differential Diagnoses & Workup
Updated: Jun 22, 2006
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Onchocerciasis
Trachoma
Uveitis, Anterior, Granulomatous
Other Problems to Be Considered
Differential diagnosis also includes the following:
Reticulum cell lymphomaSyphilis (juxta-articular nodes)
Lupus vulgaris
Lupus vulgaris (ulcerans)
Papulonecrotic tuberculid
Idiopathic hemorrhagic sarcoma of Kaposi
Filarial elephantiasis
Yaws
Paraffinoma (due to cosmetic injections of paraffin)
Cerebrotendinous xanthomatosis
Leishmaniasis
Discoid lupus erythematosus
Basal cell carcinoma
Tuberculosis colliquativa
Actinomyces mexicanus (Mycetoma)
Elastosis perforans serpiginosa
Folliculitis mucinosa
Tinea corporis
Tinea versicolor
Eczematoid dermatitis
Neurofibromatosis
Scleroma
Keratoderma sulcatum
Trachoma (scaring of tarsal conjunctiva)
Pinta
Vitiligo
Enlargement of great auricular nerves (sometimes seen in athletic young men, a physiologic variant)
Nummular eczema
Sarcoid
Histiocytosis X
Syringomyelia
Cervical rib syndrome
Lead poisoning
Unexplained facial nerve palsiesTo miss the diagnosis of Hansen disease can cause a great hardship for the affected individual because it may allow progression of the disease and leave a potential contagious person in the midst of a family. The diagnosis of the disease when the person does not have it can cause great mental suffering and can cause hardship by depriving them of treatment for their true malady. This is why a tissue diagnosis or acid-fast stained smear always should be used to establish the diagnosis in those suspected of having Hansen disease.Many of the patients with typical Hansen disease come from tropical areas of the world and may have various tropical diseases such as microfilaria along with other parasitic diseases as well as tuberculosis and syphilis.
Workup
Laboratory Studies
- Routine lab studies have little use in the diagnosis of Hansen disease but can help rule out other causes of some of the findings.
- Routine white blood counts and differential
- Serologic test for syphilis (STS) or Treponema pallidum agglutination (TPA) for syphilis
- Tuberculin/purified derivative protein (PPD) skin test
- Lepromin skin test is of little value diagnostically.
- Liver function test depending on drugs used to treat
Imaging Studies
- Chest x-ray or other lung screening imaging to check for tuberculosis (if later, it is necessary to use corticosteroids, eg, prednisone, systematically to control acute inflammatory reactions)
Procedures
- Biopsy specimens should be taken from the advancing edge of tuberculoid lesions because most normal-appearing skin will have pathologic changes. See Histologic Findings.
Histologic Findings
Tuberculoid biopsy specimens contain granulomas of lymphocytes, epithelioid cells, and foreign body giant cells. Occasionally, patients with tuberculoid form have only nonspecific chronic inflammation consisting of a scattered lymphocytic infiltration. Peripheral nerve damage may occur in sarcoidosis involving the skin, but actual nerve invasion resulting in axonal degeneration and occasionally caseous necrosis is pathonomic for Hansen disease. See Media file 2.
Specimens of patients with leprosy should be taken from nodules or plaques, although pathologic changes will be found in normal-appearing skin. Skin biopsy specimens from patients with leprosy contain vacuolated macrophages (foam cells), few lymphocytes, and numerous acid-fast bacilli often in clumps or globi. These cells persist for years even after therapy.
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 Differential Diagnoses & Workup: Hansen Disease |
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References
Allen JH, Beyers JL. The pathology of ocular leprosy I. Cornea Arch Ophth. 1960;64:216.
American Medical Association (AMA). AMA Drug Evaluations. 6th ed. Littleton, Mass: Publishing Sciences Group Inc; 1986:1548.
Centers for Disease Control and Prevention. Hansen disease. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/hansens_t.htm. Accessed 2000.
Elliott DC. An interpretation of the ocular manifestations of leprosy. Ann N Y Acad Sci. 1951;54:84-100.
Fasal P. A primer of leprosy. Cutis. 1971;7:525-534.
Fasal P. But it was not leprosy. Cutis. 1975;15:499-509.
Fasal P. Histopathology of leprosy: a tribute to Kensuke Mitsuda (1876-1964). Cutis. Jul 1976;18(1):66-72. [Medline].
Gelber RH. Leprosy. In: The Merck Manual. 17th ed. Merck & Company; 1999:1206-1209.
Hendrick SS, Wilkin JK. Leprosy. Am Fam Physician. Nov 1982;26(5):161-6. [Medline].
Holmes WJ. Leprosy of the eye. Tr Am Ophth Soc. 1957;55:145-187.
Johnson HA. A modification of the gilles, temporalis transfer for the surgical treatment of the lagophthalmos of leprosy. Plast Reconst Surg. 1962;30:378.
Masters FW, Robinson DW, Simons JN. Temporalis transfer for lagophthalmos due to seventh nerve palsy. Am J Surg. Oct 1965;110(4):607-11. [Medline].
Michelson JB, Roth AM, Waring GO 3rd. Lepromatous iridocyclitis diagnosed by anterior chamber paracentesis. Am J Ophthalmol. Oct 1979;88(4):674-9. [Medline].
Richards WW, Arrington JM. Unsuspected ocular leprosy. Am J Ophthalmol. Sep 1969;68(3):492-9. [Medline].
Shepard CC. The experimental disease that follows the injection of human leprosy bacilli into footpads of mice. Jour Exp Med. 1960;112:445.
Veterans Administration. Medical Bulletin MB-10: Hansen Disease. Veterans Administration; 1965.
World Health Organization (WHO). WHO Expert Committee on Leprosy. 7th Report. World Health Organization (WHO). Available at http://www.who.int/en/. Accessed 1998.
Further Reading
Keywords
leprosy, Hansen's disease, Mycobacterium leprae, M leprae
