Foamy giant cells – An enigma

Summary: Introduction - Leprosy is chronic bacterial infectious disease affecting skin, upper respiratory mucosa and eyes. Post treatment cases of lepromatous leprosy shows “fatty degeneration” with the appearance of more and larger vacuoles in macrophages. We report a very distinct entity having multinucleated foamy cells in various stages of development in treated case of leprosy . Case report- A 24 years old male presented with complaint of multiple areas of loss of sensation. On examination leonine facies, glove and stocking loss of sensation, hard palatal perforation was seen. Post treatment biopsy showed multinucleated large foamy cells in various stages of development ranging from aggregation to form large giant cell with foamy cytoplasm to formation of vacuoles at periphery. On Fite Farraco stain these multinucleated foamy cells were briming with bacilli. Discussion – Multinucleated giant cells has been described in tuberculoid pole of leprosy. While vacuolated giant macrophages in lepromatous leprosy have been described in isolated reports, multinucleated foamy giant cells with a foreign body-like morphology have not been documented to date. With this case report we want to highlight this unique finding in treated case of lepromatous leprosy.