An Unusual Cutaneous Manifestation of Tuberculoid Spectrum in Leprosy

Leprosy, caused by Mycobacterium leprae, is the oldest known bacterial disease to affect humans. The clinical spectrum of leprosy ranges from lepromatous leprosy (LL) or multibacillary form to tuberculoid leprosy (TT) or paucibacillary form. Lepromatous leprosy typically presents with numerous symmetrically distributed hypochromic lesions, reflecting an inability to mount an effective cellular immune response against the bacilli. In contrast, tuberculoid leprosy represents a strong cell-mediated immune response to the bacterium. Typically, this form presents as macules and plaques with asymmetrical, unilateral distribution. However, tuberculoid leprosy (TT) with near to symmetrical lesions is uncommon. We report a case of a 40-year-old woman from Kasaragod, Kerala, who visited a tertiary care center with a one-month history of asymptomatic erythematous annular plaques over both feet. Given the clinical suspicion of leprosy, a skin biopsy was performed, revealing histopathological features consistent with the tuberculoid variety. The patient was initiated on three drug Multi-Drug Therapy (MB-MDT), now recommended by WHO as uniform multi-drug treatment for all cases. This case is presented due to the unusual nature of its cutaneous manifestations.