Abstract
Lepromatous leprosy is a polar form of the disease characterized by very low to absent cell mediated immunity, resulting in unrestricted multiplication of the leprosy bacilli. This leads to infiltration and papulo-nodular lesions, which initially favor the cooler areas of the body and later become generalized. However, lepromatous leprosy may rarely be localized to a single or limited sites. Routine skin smears are negative but a skin smear and histopathology from the affected sites are confirmatory. These cases may be misdiagnosed as paucibacillary leprosy with subsequent under-treatment of the patient. Clinicians should be aware of this entity as a simple skin smear from the site can confirm the diagnosis. A 57-year old man presented with an erythematous plaque surrounded by a few satellite papules on the right hand, right ulnar paralysis and partial anaesthesia of the right hand and both feet, for one year. Slit skin smears from routine sites were negative for acid fast bacilli. However, a skin smear from the satellite lesions revealed a bacillary index of 4+. Histopathology of the skin was consistent with lepromatous leprosy. He was initiated on the WHO multibacillary multidrug therapy (MB-MDT).
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