The case of a 54-year-old man, who was referred to evaluate a consumptive syndrome with anemia and fever of unknown origin, is reported. A physical examination revealed madarosis, nodular lesions on the ears, nasal soft tissue collapse, subcutaneous nodules on arms and generalized lymphadenopathy. Laboratory tests showed anemia (Hb 8.8g/dL, mean corpuscular volume 82.4fL, mean corpuscular hemoglobin 24.5pg), normal reticulocyte count (0.5%), thrombocytosis (482×109/L), normal serum ferritin (268ng/mL) and elevated C-reactive protein (124mg/L). Serologies (viral hepatitis and human immunodeficiency virus) were non-reagent. Lepromatous leprosy was confirmed by staining for acid-fast bacilli using samples from the ear and subcutaneous nodules and bone marrow smears. Bone marrow was hypercellular with myeloid hyperplasia (myeloid–erythroid ratio 7:1) but without dysplasia. Mycobacterium leprae was detected lying free and in foamy histiocytes named Virchow cells (Figures 1 and 2).1,2 A multidrug therapeutic regimen (clofazimine, dapsone, rifampicin) was established with progressive improvement.
The authors declare no conflicts of interest.
