Hansen’s disease is a chronic granulomatous disease caused by Mycobacterium leprae that still poses challenges for clinicians because of its wide range of presentations, including atypical forms. Atypical manifestations of the disease—such as lazarine leprosy, psoriasiform leprosy, verrucous plaques, histoid leprosy, erythema annulare centrifugum, erythema gyratum repens, subcorneal pustular dermatosis, livedoid plaques, Sweet’s syndrome-like lesions and reactions resembling erythema multiforme or urticarial vasculitis and Lucio phenomenon—can mimic a variety of dermatological and systemic disorders, posing considerable diagnostic challenges, as reported in the literature. Misdiagnosis or delayed diagnosis is common, leading to preventable morbidity, disability, and ongoing transmission. This issue is further amplified in non-endemic areas where clinical suspicion is low. Variability in presentation is influenced by factors such as disease endemicity and host immune status. Unusual forms can obscure recognition. Some cases present with asymptomatic nodules, erythromelalgia, or spontaneous ulceration, further complicating diagnosis. A detailed clinical history, high diagnostic suspicion, and confirmatory investigations—including slit-skin smears and histopathology—are crucial for accurate diagnosis. Early identification of atypical leprosy presentations allows timely treatment, reduces complications, and limits disease spread.
We present six cases of leprosy with unusual clinical manifestations, namely, secondary syphilis, hand ulcers, mycetoma, sporotrichosis, purpura fulminans and Sweet’s syndrome. This case series emphasises the diverse clinical spectrum of leprosy and the need for heightened clinical awareness to avoid misdiagnosis, especially in atypical or rare presentations.
BT - Leprosy Review DA - 03/2026 DO - 10.47276/lr.97.1.2025116 IS - 1 LA - ENG M3 - Article N2 -Hansen’s disease is a chronic granulomatous disease caused by Mycobacterium leprae that still poses challenges for clinicians because of its wide range of presentations, including atypical forms. Atypical manifestations of the disease—such as lazarine leprosy, psoriasiform leprosy, verrucous plaques, histoid leprosy, erythema annulare centrifugum, erythema gyratum repens, subcorneal pustular dermatosis, livedoid plaques, Sweet’s syndrome-like lesions and reactions resembling erythema multiforme or urticarial vasculitis and Lucio phenomenon—can mimic a variety of dermatological and systemic disorders, posing considerable diagnostic challenges, as reported in the literature. Misdiagnosis or delayed diagnosis is common, leading to preventable morbidity, disability, and ongoing transmission. This issue is further amplified in non-endemic areas where clinical suspicion is low. Variability in presentation is influenced by factors such as disease endemicity and host immune status. Unusual forms can obscure recognition. Some cases present with asymptomatic nodules, erythromelalgia, or spontaneous ulceration, further complicating diagnosis. A detailed clinical history, high diagnostic suspicion, and confirmatory investigations—including slit-skin smears and histopathology—are crucial for accurate diagnosis. Early identification of atypical leprosy presentations allows timely treatment, reduces complications, and limits disease spread.
We present six cases of leprosy with unusual clinical manifestations, namely, secondary syphilis, hand ulcers, mycetoma, sporotrichosis, purpura fulminans and Sweet’s syndrome. This case series emphasises the diverse clinical spectrum of leprosy and the need for heightened clinical awareness to avoid misdiagnosis, especially in atypical or rare presentations.
PB - Lepra PY - 2026 SP - 1 EP - 8 T2 - Leprosy Review TI - Atypical leprosy revisited: adding to the expanding spectrum—a case series UR - https://leprosyreview.org/article/97/1/20-25116 VL - 97 SN - 2162-8807 ER -