Beyond Classic Leprosy: Exploring Atypical Manifestations and Their Diagnostic Challenges

Area of Science:

• Dermatology
• Infectious Diseases
• Immunology

Background:

• Leprosy (Hansen's disease) presents with varied clinical manifestations due to host immune response.
• Atypical presentations often lead to diagnostic delays and misdiagnosis.
• Early detection is crucial for treatment and interrupting transmission.

Purpose of the Study:

• To explore atypical manifestations of Hansen's disease.
• To analyze diagnostic challenges posed by non-classical leprosy presentations.
• To underscore the importance of early detection in endemic areas.

Main Methods:

• Retrospective analysis of 15 biopsy-confirmed leprosy patients.
• Inclusion of patients with diverse atypical presentations.
• Histopathological confirmation and multidrug therapy (MDT) with adjunctive steroids for ENL.

Main Results:

• Observed atypical presentations including erythema nodosum leprosum (ENL) with diverse lesions, histoid leprosy, tuberculoid leprosy mimicking other conditions, pure neuritic leprosy, and lepromatous spectrum variants.
• Six patients had ENL with varied lesions (Sweet's syndrome-like, Lucio phenomenon, erythema nodosum necroticans).
• Two patients had histoid leprosy, three had tuberculoid leprosy, two had pure neuritic leprosy, and two had lepromatous spectrum presentations.

Conclusions:

• Atypical leprosy presentations pose significant diagnostic challenges.
• Clinical awareness and prompt histopathological confirmation are vital for timely diagnosis.
• Effective management involves MDT and supportive therapy, crucial for controlling leprosy transmission.