Multibacillary Leprosy Masquerading as Exfoliative Dermatitis

The clinical presentation of leprosy may mimic many medical, rheumatological, and neurological disorders, pose diagnostic dilemma and delay treatment. Skin and nerve involvement usually occur together, although there can be nerve involvement without dermatological alterations. Early leprosy cases may lack the cardinal signs of leprosy, with nonspecific histology. Although skin smears are always negative, nerve biopsy in several cases of pure neuritic leprosy may show paucibacillary (tuberculoid) or multibacillary (MB) or borderline features. We present the clinical manifestations and morphological characteristics in a MB case presenting with peripheral neuropathy and generalized exfoliation without any specific cutaneous lesions of leprosy. The patient had clinical features of type 1 lepra reaction, poorly responsive to conventional treatment.