Unusual clinical presentations in leprosy: a case series and review

Abstract

Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease.

Uncustomary and rare presentation of Hansen’s disease ‘a mimicker’ - A narrative review

“…Syphilis and sarcoidosis were considered as great minicars in dermatology but leprosy may present with atypical manifestations mimicking other dermatoses, such as anetoderma, psoriasiform plaques, verrucous lesions, subcutaneous nodules, erythema annulare centrifugam like annular lesions, ulcers, lazarine leprosy, histoid Hansen, which may mislead the clinician. 2 Anetoderma is characterised by localised areas of loss of substance and elastic tissue with flaccid skin and often leads to a herniation phenomenon. It presents as crops of round to oval pink macules or plaques that fades and flattens from the centre outwards, leaving wrinkled, atrophic macules which yield on pressure.…”