Discrepancy between clinical manifestations and histopathological features in borderline borderline leprosy

Leprosy is a chronic and progressive granulomatous disease that primarily affects the skin and peripheral nervous system caused by Mycobacterium leprae. If left unrecognized, infection can cause permanent nerve damage and disability. The mid-borderline type is the most unstable type, where clinical presentation depends on the patient's immune response and may result in a broad spectrum of symptoms. ROM (rifampicin, ofloxacin, minocycline) is second-line therapy for leprosy recommended by WHO for patients who have contraindications or reject MDT administration. A case of a 49-year-old male patient was reported with ulcer on the right hand, peeled skin on both hands, legs, accompanied with erythematous nodules and plaque, and hyperpigmented macules almost all over body. Skin all over body were painful and followed with fever. Clinical manifestation is mimicking borderline lepromatous and severe leprosy reaction, but histopathology result support Borderline borderline leprosy. The ptient was treated with Rifampisin, Ofloxacin, Minoksiklin (ROM) and Prednison, which resulted in significant clinical improvement