Epithelioid granuloma in the iris of a lepromatous leprosy patient; an unusual finding

This case report depicts a case of histopathologically confirmed polar lepr omatous (LL) leprosy with a bacterial index of 4+, He experienced recurrent episodes of erythema nodosum leprosum (ENL) in the first 5 years after dia gnosis. Skin smears became negative after 6 years of dapsone monotherapy an d have remained negative since that time. At 23 years after diagnosis, the patient had developed cataracts and underwent intracapsular cataract extrac tions with broad-based iridectomies. In one of the iris specimens, histopat hologic examination revealed a focal granuloma composed of epithelioid cell s. Subsequently a lepromin skin test showed a positive Mitsuda reaction wit h a borderline tuberculoid histopathology. This clearly illustrates the imm unological upgrading of a polar lepromatous patient, perceived first in the iris tissue.