Beyond the cardinal signs: A case series on atypical clinical presentations of leprosy

Leprosy, or Hansen’s disease, typically presents with hypopigmented or erythematous macules with sensory loss, thickened peripheral nerves, and positive acid-fast bacilli. However, atypical presentations can lead to misdiagnosis. This case series describes six patients with unusual manifestations of leprosy, categorized into atypical sites, atypical morphology, and atypical lepra reactions. The cases include a patient with scalp lesions, another with psoriasiform plaques initially misdiagnosed as psoriasis, a case resembling nummular eczema, a patient with lymphadenopathy mimicking Kikuchi-Fujimoto disease, a case with pustular lesions, and one with features of Sweet’s syndrome. Histopathological examination was crucial in confirming the diagnosis in all cases. These cases highlight the importance of considering leprosy in the differential diagnosis of various dermatological conditions, especially in endemic areas, and underscore the role of biopsy in establishing the correct diagnosis.