Background: De Novo Histoid Leprosy is a rare and distinct variant of multibacillary leprosy that arises without prior exposure to anti-leprosy therapy and shows characteristic histopathological features with a high bacillary load [1]. Objective: This paper aims to analyze the histopathological spectrum of de novo histoid leprosy, bacillary index of granuloma (BIG) and its diagnostic significance. Materials and Methods: A retrospective analysis was performed of De Novo Histoid Leprosy cases on histopathological examination over the past 2 years (July 2023- August 2025). Results: Histopathology consistently demonstrates spindle-shaped histiocytes arranged in storiform or whorled patterns with abundant acid-fast bacilli within the granuloma, resulting in a high bacillary index [4,6]. Conclusion: Recognition of the classical histopathological pattern and high bacillary index of granuloma is crucial for accurate diagnosis of De Novo Histoid Leprosy, especially in post-elimination settings [8,10].

BIG, De Novo Histoid