Uncommon Presentations of Leprosy

Leprosy mainly presents typical features like hypopigmented, hypo anesthetic patch(es) with or without involvement of nerve(s). But in hyperendemic areas, the presentation may vary greatly, ranging from nodular, keloidal, or pustular forms of disease. We are reporting here three cases with uncommon presentations of leprosy which mimicked a wide range of dermatological conditions. The first case had a plethora of pustular lesions all over the body, resembling subcorneal pustular dermatosis (SPD). In the second case, a young male patient had just keloid-like plaques on his face; histology revealed that the condition was Histoid Hansen’s. The third case had two patches and a widespread, asymptomatic nodular eruption; the histology of this patient revealed the simultaneous presence of two distinct disease poles. All these cases developed de novo Hansen’s disease. In our cases, diagnosis was confirmed by bacteriological and histopathological assessment of patients. One of our patients presented with ‘Pustular erythema nodosum leprosum’ and another with atypical nodules and plaques mimicking other dermatological conditions. Thus, leprosy can be a “great mimicker”. Though such uncommon manifestations can also occur in low-endemic locations, these are likely to have higher incidence in hyperendemic places.