Solitary plaque of borderline lepromatous leprosy clinically masquerading as paucibacillary leprosy

Borderline lepromatous (BL) leprosy typically manifests as numerous asymmetric ill-defined macules or infiltrated plaques. Localized cutaneous involvement in BL leprosy is infrequently reported. Type 2 reaction (T2R), an immune complex syndrome, occurs in patients with BL and lepromatous leprosy, as crops of tender evanescent papules or nodules with constitutional symptoms. T2R can also present with various atypical morphologies and rarely as type 1 reaction (T1R), thereby creating a diagnostic dilemma.