Atypical Hansen's disease presenting as florid verrucous plaques on the lower extremities: a case report

Verrucous leprosy is rare, with only 18 cases reported in the literature. Visceral involvement is frequent but often overlooked, causing significant morbidity and mortality.

A 45-year-old Filipino male with a 16-year history of hyperpigmented, hypoesthetic plaques, amputated digits, enlarged ulnar nerve, and cardiovascular congestion was diagnosed with Hansen's disease-lepromatous type. He had multiple cauliflower-like nodules and plaques with foul-smelling discharge on the lower extremities presenting a diagnostic dilemma. After an exhaustive search, the causative agent for these verrucous nodules was confirmed to still be Mycobacterium leprae. In addition, he had glomerulonephritis, hypertension, congestive heart failure, deep venous thrombosis, neuritis, keratitis, and glaucoma, which are all complications of advanced leprosy and multiple attacks of erythema nodosum leprosum reactions.

He was treated with a multibacillary regimen of Rifampicin, Dapsone, Clofazimine, and systemic corticosteroids, with remarkable improvement.