Unusual presentation of borderline lepromatous leprosy involving palms and soles: A case report

Leprosy has a predilection for areas with relatively low temperatures, like skin, peripheral nerves, testes, and eyes. Hence, owing to their high temperature, palms and soles are referred to as immune zones. Hereby, we report a case of leprosy with palmoplantar involvement. A 26-year-old female presented with multiple, erythematous, indurated papules and plaques on the palms and soles bilaterally for 6 months. Peripheral nerve examination revealed thickening of ulnar, radial cutaneous, and common peroneal nerves bilaterally, with no neuritis. Differentials of borderline lepromatous leprosy, palisaded neutrophilic and granulomatous dermatitis, cutaneous sarcoidosis, and secondary syphilis were kept. A slit-skin smear was positive for lepra bacilli. Histopathological findings were suggestive of borderline lepromatous leprosy in type 1 reaction. Although leprosy has been eliminated from the majority of countries worldwide, atypical and uncommon manifestations continue to occur. Having a high index of suspicion is crucial in diagnosing such cases.