An atypical case of leprosy mimicking a lichenoid eruption

Lesions of leprosy may often be ignored or misdiagnosed due to atypical morphologies, thereby delaying treatment. We describe a case of Leprosy closely mimicking a lichenoid dermatosis. A 52-year-old male admitted with hemiplegia following a cerebrovascular accident was referred to the dermatologist with pruritic violaceous papules and plaques over his body for the past 5 years, clinically suggestive of lichen planus. A few lesions however appeared unusual showing pseudopod-like projections, satellite papules or atrophy. There was no history of sensory loss or prior motor weakness. Skin biopsy showed foam cells and clumps of acid-fast bacilli and based on this diagnosis was revised to lepromatous leprosy. This case was notable in view of its uncommon presentation. We emphasize that in endemic areas a high degree of suspicion is required to correctly diagnose cases of leprosy. A detailed clinical evaluation and slit-skin smears or biopsies of suspicious lesions may help reduce misdiagnosis.