Localized lepromatous leprosy in household contact of multibacillary disease

Lepromatous leprosy (LL) is a generalized disease, usually with numerous papules, nodules, or plaques containing abundant Mycobacterium leprae and affecting wide areas of the skin.

To report on an LL patient presenting with two lesions on the face and to discuss its epidemiologic significance in the current context of leprosy elimination.

A 52-year-old housewife presented to our department with erythematous lesions over her face for 2 months. Her husband and son were treated for multibacillary leprosy 15 years previously. An infiltrated erythematous nodule was located over the right supraorbital area, and a single papule was present on the right eyelid. The rest of the examination was normal.

A slit skin smear from the lesion revealed a bacillary index of 6+ and a morphologic index of 6%. A skin biopsy showed atrophic epidermis with an underlying clear grenz zone; the dermis showed massive infiltration of foamy macrophages, filled with bacilli and a few lymphocytes.

The presentation of LL or borderline lepromatous leprosy (BL) as a single cutaneous lesion (or localized lesions) is a rare presentation of multibacillary disease, and such cases can be undertreated. This case also highlights the need to further explore the role of immunoprophylaxis or chemoprophylaxis in the contacts of multibacillary cases.