Hansen's Disease: A Great Mimicker

Leprosy is a dermato-neurological chronic infection caused by Mycobacterium leprae, an acid fast intracellular bacilli, not cultivated in vitro. Leprosy predominantly affects the skin and peripheral nerves. The different manifestations of leprosy are known since time immemorial. But even today when we are trying hard to eradicate leprosy, newer forms of presentation continue to crop in the form of laryngeal dyspnoea, bullae with hematoma, xanthoma like presentation etc. Granuloma annulare (GA) is typically a benign, self-limited cutaneous disorder classically presenting as annular groups of skin-colored to erythematous papules and plaques without epidermal change localized to the dorsal hands and or feet. A 50-years-old hypertensive, diabetic female patient presented with suddenly appearing multiple asymptomatic red raised lesions limited to bilateral upper limbs since 2 months. On examination multiple papules and plaques of size varying from 2cm-5cm in diameter were present. The individual lesions were round shaped, flat topped, non-scaly, indurated plaques with central clearing and hyperpigmentation. There was no loss of sensation (touch, pain), thickened nerves or muscle weakness. No signs of any atrophy and hair loss over plaques.Abiopsy was taken for the confirmation of diagnosis and it was suggestive of borderline lepromatous leprosy. Skin and nerves affected by leprosy is quite common. However, it is a great mimic of many conditions. In areas endemic for leprosy it is imperative to keep in mind the diverse presentations of leprosy. Leprosy should be actively ruled out in all suspected cases so as to prevent misdiagnosis.