Erythematous macules as an atypical presentation of paucibacillary leprosy

Leprosy, caused by Mycobacterium leprae, remains a significant health concern in certain endemic regions despite global elimination efforts. This case describes a 53-year-old Moroccan woman presenting with a 1-year history of asymptomatic erythematous macules associated with sensory deficits. Initial diagnoses included common dermatological conditions, leading to delays in definitive treatment. A detailed clinical examination revealed hallmark sensory loss in the lesions, with dermoscopy and histopathology supporting a diagnosis of paucibacillary leprosy. While bacilloscopic findings were negative, histological analysis demonstrated lymphocytic infiltration around nerve fibres, consistent with leprosy criteria. The patient was successfully managed with multidrug therapy and educational reinforcement to promote adherence. Additionally, chemoprophylaxis with single-dose rifampicin was administered to household contacts, as recommended by the World Health Organization. This report underscores the diagnostic challenges in paucibacillary leprosy, where overlapping clinical features may mimic other dermatoses. It highlights the crucial roles of histopathology, dermoscopy and systematic neurological evaluations in confirming diagnoses, especially in resource-limited settings. Early diagnosis, effective treatment and preventive strategies, including chemoprophylaxis, remain essential to reducing transmission and minimizing stigma in leprosy-endemic regions. The case emphasizes the continued vigilance required of dermatologists to recognize rare presentations and contribute to global eradication efforts.