A Spindle Cell Tumor in Disguise: Histoid Nodules Arising From Peripheral Nerves

A 25-year-old male presented with multiple, painless subcutaneous nodules, each measuring 5-6 mm, attached to thickened superficial cutaneous nerves. He also had nodular infiltration of the left earlobe. Histopathology revealed spindle-shaped histiocytes in a storiform pattern, with numerous acid-fast bacilli in Fite-Faraco staining. Skin slit smear from the nodule revealed a bacteriological index of +6. Ultrasonography of the nodule revealed a well-defined, avascular, heterogenous hypoechoic lesion over a focally thickened nerve with loss of fibrillary pattern, confirming a rare form of neural histoid leprosy.