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[A case suspected multibacillary leprosy].

The presence of acid-fast bacilli in the lesion and its positive culture usually provide the diagnosis in cutaneous mycobacteriosis. But in diagnosis of leprosy, characteristic clinico-histopathological findings are so important as the demonstration of the organism, because of the failure to grow Mycobacterium leprae in vitro. It is classified in various forms along a spectrum of infectious and immunological symptoms supported by the pathogen-host relationship. The patient was a Japanese woman 69 years of age. She had been diagnosed as multibacillary leprosy with the positive results of slit-smear tests and the confirmation of the genomic sequence by PCR. Multidrug therapy had been started, but it was discontinued afterwards because an exact diagnosis of leprosy could not be determined by clinical, histological, and immunological assessment. As its diminishing prevalence in Japan, where ordinary physicians cannot have opportunities to see leprosy patients and they are unfamiliar with protean manifestations of the disease, it can be very difficult to make accurate diagnosis in those cases with atypical findings.