A 35 year old patient with skin lesions

Short case final exam 

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SHORT CASE

35 year old male patient, Resident oframchandrapuram ,HYD,works as daily wage labourer .

Who is a chronic smoker(1 pack of beedi every 2 days )  and taking alcoholic (90 ml daily ) since 20 years 

Presented with 3 months history of painless lesions - papules with erythema  that started initially over face then extended to upper limb and lower limb ,trunk .

No hypodense lesions ,no fever ,no pus discharge ,no loss of sensation ,no genital lesions .

Patient got topical cream ,soap and some oral drugs from medical shop - OTC 

He used for 2 months ,few lesions regressed ,but few persisted on nose ,earlobe and on trunk ,hands ,legs .

14 days back patient developed blackish  skin discoloration over hands and feet with skin peeling ,cracking ,ulcer formation - associated with burning sensation and 

erythema all over the body.

No new lesions were noted .

Since 4 days patient developed high grade fever associated with chills and rigors , continuous .

Loss of appetite + 

No known comorbidities .

No history of similiar complaints in the past .

On examination : 

Face - 

Loss of eye brows 

Thickened earlobe 

Multiple Papules with erythema over face ,limbs ,trunk 

Oral cavity - 

Palate - dark ,erythematous lesion.

Diagnosis - 

Hansen’s disease