Bilateral Lower Limb Sensory Motor Neuropathy as the Initial Manifestation of Borderline Tuberculoid Leprosy: A Diagnostic Challenge

Leprosy primarily affects the skin and peripheral nerves, with neuropathy usually accompanying skin lesions. Rarely, neural involvement may precede cutaneous manifestations, leading to diagnostic delay. We report the case of a 36-year-old male presenting with bilateral lower limb sensory motor neuropathy initially attributed to Vitamin B12 deficiency. Despite normalization of B12 levels, symptoms persisted, and subsequent skin changes led to biopsy confirmation of borderline tuberculoid leprosy. This case emphasizes considering Hansen’s disease in patients with unexplained neuropathy, particularly in the endemic regions, even before overt skin lesions appear.