Paresthesia as an Initial Presentation of Hansen's Disease in a Non-endemic Setting

Leprosy or Hansen's disease is an infectious disease caused by the intracellular organism Mycobacterium leprae (M. leprae). The disease has a low prevalence in the United States and follows an indolent course with symptoms often manifesting several years after initial exposure. Reaching a diagnosis of Hansen's disease can often be challenging in a non-endemic setting. Additionally, reaching a diagnosis in the absence of skin symptoms is difficult, as the diagnostic method that provides the most clinical reliability is a skin biopsy or slit skin smear (SSS). Through this skin test, the acid-fast bacillus M. leprae is visualized. We present a case of a 55-year-old woman from California who initially presented with neuropathy and continued to suffer from three years of progressive sensory and motor neuropathies before the diagnosis of Hansen's disease. She lived in a non-endemic setting but was likely exposed through her work in medical tourism in Playa del Carmen, Mexico. A diagnosis was ultimately reached once she presented with skin lesions that allowed for a biopsy. This case also highlights the challenge in reaching a timely diagnosis of Hansen's disease, which, due to its low prevalence in North America, can often be overlooked in a differential diagnosis.