Correlation of clinico-pathological classification of hansen’s disease in a South Indian city

Hansen’s Disease (HD) presents itself in different forms depending on the individual’s immune status, and based on this Ridley-Jopling classified the disease into five sub-groups. The aim of this study was to evaluate the role of histopathology and bacteriological index (BI) in accurate staging of HD with clinical correlation. Fifty HD patients with clinical diagnosis confirmed by histopathology were included. Patients in reaction and on treatment were excluded. Case records and histopathological slides were viewed and BI was recorded. In 10/50 cases, a diagnosis of HD was made or suspected, but were not clinically classified. In these, histopathology proved useful in diagnosis and classification. Indeterminate HD was the most common histopathological diagnosis (6 cases). The remaining 40 patients, were clinically classified using the Ridley- Jopling classification, as Indeterminate Leprosy (IL) in 10/40 (25%), Tuberculoid Leprosy (TT) 5/40 (12.5%), Borderline Tuberculoid (BT) 16/40 (40%), Borderline Lepromatous (BL) 4/40 (10%) and Lepromatous Leprosy (LL) 5 (12.5%). HD was common in males with male to female ratio of 1.66:1 and affected the younger individuals (maximum in 21 to 30 years). On histopathology BT was the most common type (40%) followed by IL (27.5%), BL (12.5%), TT (10%) and LL (10%). No case of Mid-Borderline (BB) type was diagnosed clinically or histopathologically. Overall concordance between clinical and histopathological diagnosis was 65% (26/40 cases) and for each type was IL=80%, TT=20%, BT=75%, BL=50% and LL=60%. Where classification seemed difficult as in cases of BT and BL, BI played an important role. The overall concordance between clinical classification and histopathological diagnosis of HD is 65% in this study. The discordance that is observed is between BT and TT, the paucibacillary type and BL and LL the multibacillary type and hence the treatment is not affected. Overall, IL was a common diagnosis on histopathology in this study (11/40 cases and 6/10 cases). If clinically warranted, a repeat deeper punch of skin biopsy may be required for a proper categorization of the cases.