Leprosy, caused by Mycobacterium leprae , can pose diagnostic challenges in non-endemic regions because of its low frequency and possible atypical presentations. This case describes the unusual clinical manifestations of leprosy in a 52-year-old Indian woman who immigrated to Italy: she presented with a granulomatous nasal plaque and hypopigmented abdominal lesion, without evidence of sensory loss or peripheral neuropathy. Initial evaluations were inconclusive, causing a significant diagnostic delay. Definitive diagnosis was achieved by molecular test for Mycobacterium leprae from respiratory and skin samples. After 12 months of multidrug therapy, the nasal lesion resolved completely. This case highlights the imperative for health care providers in nonendemic settings to always consider leprosy in the differential diagnosis of chronic dermatologic conditions, especially in individuals with relevant epidemiologic background, even in absence of typical manifestations, emphasizing the need for high clinical suspicion and multidisciplinary collaboration.
Ponzetta et al. (Sun,) studied this question.