Beyond Classic Leprosy: Exploring Atypical Manifestations and Their Diagnostic Challenges

Leprosy, or Hansen’s disease, is an ancient infectious disease characterized by varied clinical presentations influenced by the host's immune response. This study aimed to explore the atypical manifestations of Hansen’s disease in a cohort of 15 biopsy-confirmed patients admitted to the Department of Dermatology, Venereology & Leprosy at a tertiary care center in Andhra Pradesh, India. There were 14 male patients and one female patient, with a mean age of 42.8 years. Notably, six patients presented with erythema nodosum leprosum (ENL), showing diverse atypical manifestations such as Sweet’s syndrome-like lesions, Lucio phenomenon, and erythema nodosum necroticans. Two patients were classified under the histoid spectrum with multiple asymptomatic nodular lesions, while three exhibited tuberculoid features mimicking conditions like granuloma annulare and urticarial vasculitis. Additionally, two cases of pure neuritic Hansen’s disease were observed, presenting with isolated nerve involvement and significant sensory impairment. The last two cases presented with lepromatous spectrum-simulating erythromelalgia and spontaneous ulceration of both hands. This study aims to address the diagnostic challenges posed by atypical presentations of leprosy, which often lead to delays in diagnosis and, in some cases, misdiagnosis. Initially, all the patients exhibited symptoms that were not typical of classic leprosy, resulting in diagnostic delays. After histopathological confirmation, they were treated with multidrug therapy (MDT), with systemic steroids added for those with ENL to manage severe inflammatory responses. This study emphasizes the critical importance of clinical awareness and early detection, particularly in endemic regions, to facilitate prompt intervention. Timely recognition and treatment are essential to interrupt the transmission cycle and progress toward a leprosy-free world.