Multibacillary Lepromatous Leprosy in an Endemic Area: A Two-Year Diagnostic Delay and the Role of Slit-Skin Smear and PCR - Cureus

Multibacillary lepromatous leprosy can mimic other dermatological conditions, delaying diagnosis. In areas with limited access to histopathology, the slit-skin smear (SSS) is an accessible tool that, together with clinical findings, can support the diagnosis and the start of treatment, while PCR of SSS material may provide complementary confirmation. A 63-year-old male from Montería (Córdoba, Colombia), with a history of chronic venous insufficiency, presented with a two-year history of characteristic skin lesions, including nodular infiltration of the earlobe, a hyperkeratotic plaque with hypoesthesia on the right elbow, and diffuse cutaneous involvement of the chest and abdomen. SSS of the earlobe showed acid-fast bacilli with a bacterial index of 4+ (Ridley scale). Based on the clinical findings and the smear result, multibacillary lepromatous leprosy was diagnosed, and multidrug therapy was started per the WHO regimen without histological confirmation. Real-time PCR performed approximately two and a half months later was positive for Mycobacterium leprae, and a skin biopsy performed about 18 months after diagnosis showed foamy histiocytes consistent with the lepromatous pole. A

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatous vasculitis classically involving the upper and lower respiratory tracts and kidneys. Timely diagnosis requires a high index of suspicion for the presenting symptoms. Otolaryngologic manifestations are commonly reported but most often involve the nasal and paranasal sinuses. Sensorineural hearing loss (SNHL) as the sole initial manifestation of GPA is uncommon and may contribute to diagnostic delay. We report a case of a 67-year-old male who presented with rapidly progressive bilateral SNHL that preceded pulmonary and renal manifestations by several months, during which the patient was treated for otitis externa and Eustachian tube dysfunction without improvement. Development of pulmonary symptoms prompted additional workup, which demonstrated markedly elevated cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) and proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), raising concern for GPA. Histopathology then confirmed the diagnosis. The patient was treated with high-dose corticosteroids and rituximab with serologic remission; however, his hearing loss was largely irreversible. This case

What if the human brain works in ways that Sigmund Freud began describing more than 130 years ago? A new scientific analysis suggests that some of his ideas about the mind share surprising similarities with one of the most influential theories in modern neuroscience. Published in the scientific journal Entropy, the paper explores connections between Freud's original theories, later developments in psychoanalysis, and a modern approach to brain research known as the prediction paradigm.