Question:medium
A 38-year-old patient with hypopigmented nodular lesions with anesthesia overarm with ulnar nerve involvement underwent a biopsy and intradermal antigen test. Based on the image, which statement regarding the condition is most accurate?
A 38-year-old patient with hypopigmented nodular lesions with anesthesia overarm with ulnar nerve involvement underwent a biopsy and intradermal antigen test. Based on the image, which statement regarding the condition is most accurate?
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In cases of lepromatous leprosy, look for nerve involvement and skin lesions. A negative antigen test helps distinguish this from other types of leprosy.
Updated On: Jun 22, 2026
- Tuberculoid leprosy with a positive antigen test
- Lepromatous leprosy with a positive antigen test
- Erythema nodosum leprosum with a negative antigen test
- Lepromatous leprosy with a negative antigen test
Show Solution
The Correct Option is D
Solution and Explanation
Step 1: Localise the disease.
Hypopigmented (and here nodular) skin lesions with sensory loss over them, plus a thickened/involved ulnar nerve, point firmly to leprosy (Hansen's disease, caused by Mycobacterium leprae). The remaining job is to place the patient on the immunological spectrum and predict the lepromin (intradermal antigen) test result.
Hypopigmented (and here nodular) skin lesions with sensory loss over them, plus a thickened/involved ulnar nerve, point firmly to leprosy (Hansen's disease, caused by Mycobacterium leprae). The remaining job is to place the patient on the immunological spectrum and predict the lepromin (intradermal antigen) test result.
Step 2: Recall what the lepromin test measures.
The lepromin (Mitsuda) test is NOT a diagnostic test for leprosy; it gauges the host's cell-mediated immune response to the bacillus. A robust T-cell response produces a positive reaction; a feeble response gives a negative one.
The lepromin (Mitsuda) test is NOT a diagnostic test for leprosy; it gauges the host's cell-mediated immune response to the bacillus. A robust T-cell response produces a positive reaction; a feeble response gives a negative one.
Step 3: Read the burden of disease from the lesions.
Multiple nodular lesions reflect a high bacterial load and poor containment of the organism. Few, well-defined lesions would suggest the opposite. Heavy, multibacillary, nodular disease is the lepromatous end of the spectrum.
Multiple nodular lesions reflect a high bacterial load and poor containment of the organism. Few, well-defined lesions would suggest the opposite. Heavy, multibacillary, nodular disease is the lepromatous end of the spectrum.
Step 4: Couple the pole with the expected test.
• Tuberculoid leprosy = strong immunity, granulomas, few lesions → lepromin positive.
• Lepromatous leprosy = weak immunity, widespread/nodular disease → lepromin negative.
Because the picture is nodular and multibacillary, immunity is poor, so the antigen test will be negative.
• Tuberculoid leprosy = strong immunity, granulomas, few lesions → lepromin positive.
• Lepromatous leprosy = weak immunity, widespread/nodular disease → lepromin negative.
Because the picture is nodular and multibacillary, immunity is poor, so the antigen test will be negative.
Step 5: Eliminate the distractors.
• Tuberculoid with a positive test contradicts the nodular, high-load presentation.
• Lepromatous with a positive test is internally inconsistent - the lepromatous pole gives a negative test.
• Erythema nodosum leprosum is a reactional (immune-complex) flare, not the baseline diagnosis being asked, and the option pairs it with the wrong test logic.
• Tuberculoid with a positive test contradicts the nodular, high-load presentation.
• Lepromatous with a positive test is internally inconsistent - the lepromatous pole gives a negative test.
• Erythema nodosum leprosum is a reactional (immune-complex) flare, not the baseline diagnosis being asked, and the option pairs it with the wrong test logic.
Final answer: The accurate statement is Option 4 - Lepromatous leprosy with a negative antigen test.
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