A 51-year-old woman previously treated for multibacillary leprosy presented with polyarthritis of wrists, ankles and small joints of the hands, resembling rheumatoid arthritis. She had completed multidrug leprosy therapy in 2014 and had a previous history of erythema nodosum leprosum treated with corticosteroids. Slit-skin smear demonstrated acid-fast bacilli and skin biopsy confirmed granulomatous inflammation consistent with leprosy. She was treated with anti-inflammatory therapy and rehabilitation measures, resulting in gradual clinical improvement.

Lepromatous reaction mimicking a primary systemic vasculitis: Case report and literature review.

Background: Multibacillary leprosy management is frequently complicated by severe immunological reactions and adverse drug events. Erythema nodosum leprosum is an immune-complex-mediated complication, while dapsone hypersensitivity syndrome is an idiosyncratic, potentially life-threatening drug reaction. The concomitant presentation of these distinct entities, especially with bullous eruptions, creates a profound diagnostic and therapeutic dilemma. Case presentation: A 42-year-old male with a history of relapsed borderline lepromatous leprosy and rheumatoid arthritis presented with exquisitely painful erythematous nodules, high-grade fever, and bullous eruptions exactly 72 hours after the re-initiation of multidrug therapy. Physical examination recorded a Visual Analog Scale pain score of 9. Expanded histopathological evaluation confirmed a dual pathology: extensive dermal neutrophilic infiltration characteristic of Erythema Nodosum Leprosum, occurring alongside pronounced subepidermal blistering and marked eosinophilic exocytosis indicative of a dapsone-induced bullous eruption. Standard multidrug therapy was immediately discontinued. A modified regimen comprising rifampicin, clarithromycin, and carefully titrated immunosuppressants (methylprednisolone and azathioprine) was initiated. Conclusion: The substitution of dapsone with clarithromycin facilitated rapid clinical resolution of both the bullous eruptions and recurrent immune reactions. This case underscores the critical need for precise temporal tracking, individualized therapeutic modifications, and comprehensive histopathological evaluation in leprosy patients demonstrating complex, overlapping hypersensitivity syndromes.

Leprosy is a chronic infectious disease with diverse clinical manifestations. Skin lesions may present as erythema, nodules, ulcers, bullae, or verrucous hyperplasia. When skin lesions and neurological symptoms are atypical, misdiagnosis is common. When patients develop rare skin lesions resembling pretibial myxedema, clinicians often misdiagnose the condition as hyperthyroidism or mucin deposition disorders. Such misdiagnoses can delay appropriate treatment and may lead to serious complications. We report a 74-year-old male with progressive bilateral pretibial edema and multiple translucent nodular lesions for over six months, accompanied by intermittent high-grade fever. The skin lesions were repeatedly misinterpreted as pretibial myxedema despite the absence of Graves’ disease and the presence of only subclinical hypothyroidism. Repeated bacterial smears obtained from ulcer exudates were negative, which may have contributed to further delaying diagnosis. Histopathological examination of nodular lesions revealed diffuse infiltration of foamy histiocytes with a heavy acid-fast bacillary load, confirming multibacillary leprosy with type 2 lepra reaction (erythema nodosum leprosum). Treatment with rifampicin and clofazimine, combined with systemic corticosteroids, resulted in rapid clinical improvement. Pretibial myxedema-like lesions in this patient represented chronic edema and nodular changes associated with lepromatous leprosy rather than true pretibial myxedema. This case highlights a common diagnostic pitfall and underscores the importance of early histopathological evaluation and heightened clinical suspicion to prevent delayed diagnosis and irreversible complications. Not applicable.

BackgroundIn HLA-B*13:01-positive multibacillary (MB) leprosy patients, dapsone-containing multidrug therapy (MDT) carries a high risk of dapsone hypersensitivity syndrome (DHS). Alternative regimens (dapsone-free) are adopted, but their long-term efficacy compared with standard MDT in HLA-B*13:01-negative patients remains inadequately characterized.MethodologyThis retrospective cohort study analyzed MB patients (2015–2023) from the National Leprosy Prevention and Control Management Information System (LEPMIS) with ≥1-year follow-up. Primary outcomes (cure/relapse rates, bacterial index (BI), leprosy reactions, and disability progression) and secondary outcomes (adverse events and treatment duration) were compared between HLA-B*13:01-positive patients receiving alternative therapy (rifampicin + clofazimine ± clarithromycin/ofloxacin/minocycline) and negative patients receiving standard MDT (rifampicin + clofazimine + dapsone).FindingsAmong the 271 enrolled MB patients (120 HLA-B*13:01-positive, 151 negative), alternative therapy showed comparable efficacy to standard MDT in cure rates (67.6% vs. 65.8% at Year 5), the rate of BI decline (89.92% vs. 95.11% at Year 5), smear negativity rates (71.43% vs. 75.00% at Year 5) and relapse rates (0.46 vs. 0.20 per 100 person-years). Kaplan-Meier survival functions revealed no significant differences in leprosy reactions or disability progression. Additionally, alternative therapy demonstrated comparable safety to MDT (1.67% vs. 2.65%, P = 0.70).ConclusionsIn our study, dapsone-free alternative regimens demonstrated comparable clinical efficacy and safety to standard MDT in MB patients, providing a viable option for HLA-B*13:01 carriers. These findings, limited by the observational design and regimen heterogeneity, warrant further investigation in prospective trials.

Background: Lucio’s phenomenon is a rare and severe vasculonecrotic complication of diffuse lepromatous leprosy, characterized by extensive necrotic skin lesions due to massive endothelial bacillary proliferation. It typically occurs in untreated or inadequately treated patients. Case Presentation: We report the case of a 52-year-old male presenting with chronic, diffuse necrotic skin ulcers, a leonine facies, and peripheral neuropathy. History revealed macular hypopigmented lesions dating back 20 years. Skin smears showed a high bacillary index (5+). A diagnosis of Lucio’s phenomenon revealing advanced lepromatous leprosy was established. The patient was treated with WHO-recommended multibacillary multidrug therapy, resulting in significant clinical improvement. Conclusion: Lucio’s phenomenon represents a diagnostic and therapeutic emergency in multibacillary leprosy. Prompt recognition, rapid bacteriological confirmation, and early initiation of multidrug therapy are crucial to prevent severe functional and systemic complications

Changes in neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios after multidrug therapy in multibacillary leprosy

Diagnostic evaluation of a novel recombinant multi-epitope protein for paucibacillary and multibacillary leprosy.

Multibacillary leprosy in a migrant worker

Current WHO MBMDT regimen has largely been successful in treating leprosy patients since 1984, when it was implemented worldwide. According to clinical presentation, pauci and multibacillary leprosy, the regimen is also given for 6 or 12months. However, this regimen has its limitations, such as incomplete bacterial clearance, prolonged treatment duration and poor patient compliance, necessitating administration of alternative and more effective regimens. Secondly, there is a subset of patients who are highly bacillated and continue to harbour viable bacilli even after treatment and thus continue transmission. We present the protocol of WHOMDT vs. monthly regimen of rifampicin, moxifloxacin and clarithromycin (RMC), a randomised clinical trial designed to test the efficacy of the RMC regimen in the management of multibacillary leprosy. MB MDT vs RMC clinical trial is multicentric which will be conducted in accordance with the CONSORT guidelines in The Leprosy Mission Trust India's tertiary care hospitals at Delhi, Uttar Pradesh, West Bengal and Chhattisgarh. Naive MB leprosy patients who consent to participate will be randomly allocated to receive 12months of WHO MB MDT or a monthly regimen of rifampicin, moxifloxacin and clarithromycin. The primary objective will be to evaluate the efficacy of monthly RMC regimen compared to the WHOMBMDT in treating multibacillary leprosy. Molecular viability assay will be used to assess the efficacy of the regimen. Monitoring of adverse events will be closely done. Results will be submitted for publication in peer-reviewed journals. Ethical approval has been obtained from The Leprosy Mission Trust India's ethics committee (TLMTI/EC/C-69). This study is registered at Clinical Trials Registry-India (CTRI) - CTRI/2024/03/064435.

Introduction: Leprosy remains a public health challenge in India, not merely due to medical reasons but because of persistent stigma and deep-rooted cultural beliefs that influence health-seeking behaviour. This case report describes a 28-year-old woman with borderline tuberculoid leprosy who delayed seeking medical care due to cultural beliefs. Result: After an 8-month delay in seeking medical care, the patient presented with a hypopigmented, hypoesthetic patch over the right knee, along with thickening of the right common peroneal nerve. Notably, two sets of intersecting tattoo lines were observed over the lesion applied by a traditional healer in an attempt to contain the disease. Histopathology confirmed a diagnosis of borderline tuberculoid leprosy, and high-resolution ultrasonography corroborated peripheral nerve involvement. The patient was subsequently given multidrug therapy for multibacillary leprosy, adult regimen for 12 months and received detailed counselling on disease management.Discussion: The case highlights how cultural practices can hinder early diagnosis and effective management. Culturally sensitive health education is essential to combat stigma and improve leprosy control.

This study aimed to evaluate serum brain-derived neurotrophic factor levels, stress, and quality of life in leprosy patients, and to explore their interrelations. A cross-sectional study was conducted from September 2024 to May 2025 at 3 hospitals in Medan, Indonesia, involving 45 leprosy patients aged ≥ 18 years who met inclusion criteria. Serum brain-derived neurotrophic factor levels were measured using ELISA, stress was assessed using the Perceived Stress Scale-10, and quality of life was evaluated through the WHOQOL-BREF questionnaire. Descriptive statistics, Shapiro-Wilk normality test, and Spearman's rank correlation were used for analysis. The mean serum brain-derived neurotrophic factor level was 7.38±3.37 ng/mL. Patients with multibacillary leprosy without reaction had higher brain-derived neurotrophic factor levels than those with type 1 or type 2 reactions. Stress levels were mild in 42.22% and severe in 28.89% of patients. Quality of life scores varied widely. A strong negative correlation was found between brain-derived neurotrophic factor and stress (r=-0.953, p< 0.0001), and a strong positive correlation between brain-derived neurotrophic factor and quality of life (r=0.962, p< 0.0001). These findings suggest that serum brain-derived neurotrophic factor levels are associated with psychological well-being in leprosy patients and may serve as a potential biomarker for mental health monitoring in this population.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects the peripheral nerves, skin, and other body tissues. In addition to medical consequences, leprosy poses complex social, economic, cultural, and public health challenges. The Tirtayasa Public Health Center oversees 14 villages with a total population of 50,937 people. As part of leprosy elimination efforts, the center developed the BECAK Tirtayasa Innovation, aimed at supporting the achievement of Triple Zero leprosy. This innovation includes the development of a leprosy counseling module, the formation of BECAK Tirtayasa cadres, establishment of a telemedicine group connecting cadres, leprosy officers, and doctors, implementation of health education and educational games on leprosy, active Intensified Case Finding (ICF), and provision of chemoprophylaxis. To analyze the utilization of the BECAK Tirtayasa Innovation in reducing leprosy prevalence in the Tirtayasa Public Health Center area in 2024. This study employed an observational analytical cross-sectional design involving 50 respondents selected through total sampling from leprosy cases recorded between 2019 and 2024. Most leprosy patients were adults aged 20–60 years (44 individuals; 88.1%) and male (27 individuals; 54%). The highest proportion of cases originated from Lontar Village (12 individuals; 24%). Multibacillary leprosy predominated (44 individuals; 88%), and the majority of patients presented with grade 1 disability (23 individuals; 46%). The highest number of leprosy cases was recorded in 2019 (17 cases), while the lowest occurred in 2024, with only one new case identified. In 2024, the implementation of the BECAK Tirtayasa Innovation was associated with a decrease in leprosy prevalence to 0.1 per 10,000 population and achievement of the new case detection target at 1.9 per 100,000 population. No grade 2 disability cases or pediatric leprosy cases were reported (0%), and the treatment completion rate exceeded the national target (100%). Leprosy cases in the Tirtayasa Public Health Center area predominantly affected adult males, were mostly multibacillary in type, and commonly presented with grade 1 disability. The BECAK Tirtayasa Innovation contributed to a reduction in leprosy prevalence and supported progress toward Triple Zero leprosy in the Tirtayasa Public Health Center area.

Introduction: Co-infection of Tuberculosis (TB) and Leprosy is a rare occurrence, even in endemic areas.1 This co-infection has higher risks of drug resistance, complications, and mortality.2,3 Case Report: A 38-year-old male patient, who had been taking long-term steroids, presented in severe condition, showing signs of sepsis and ARDS. Multilobar infiltrates were found in both lungs, MTB/RIF was positive and sensitive to Rifampicin, BTA was found in slit skin smear test, liver enzyme levels were elevated, D-dimer level was increased (6 mg/L), low PaO2/FiO2 ratio (44.25 mmHg), along with an increased AaDO2 (508.4 mmHg). Despite receiving antimicrobial and anti-tuberculosis therapy, the patient's condition continued to deteriorate, resulting in septic shock and death. Discussion: The rarity of these cases in the modern literature is likely due to Bacillus Calmette-Guérin (BCG) vaccination in endemic areas, which provides at least partial protection against both diseases. Dual infection is associated with higher morbidity (5.5%) and mortality (37.2%).2 Appropriate diagnostic, screening, and therapeutic regimens are needed in clinical practice to prevent the risk of drug resistance and complications. This study aimed to present a complicated case of pulmonary TB and multibacillary leprosy co-infection in a septic patient.

BackgroundLeprosy poses a significant challenge in low- and middle-income nations, particularly in certain geographies. While the MDT-MBR regimen has proven beneficial, treatment non-responsiveness remains a key obstacle to eradicating leprosy. Considering bedaquiline's promising outcomes in MDR-TB and pre-clinical leprosy investigations, this proof of concept study aims to ascertain bedaquiline's efficacy and pharmacokinetics-pharmacodynamics in patients with non-responsive multibacillary leprosy.MethodsThe study has two components- preclinical and clinical. Leprosy mouse footpad model was developed by inoculating M.leprae ( in BALB/C mouse footpad. Groups of animals using different dosing schedules and regimens for bedaquiline are compared against WHO-MDT regimen. Additionally, drug interaction study for evaluating interaction with concomitantly administered drugs was carried out in Swiss albino mice. For clinical study, a prospective, randomized, blinded end point assessment trial comparing bedaquiline based regimen with that of extended WHO-MDT regimen is being undertaken in treatment non responsive patients of leprosy (CTRI Registration No: CTRI/2022/09/045483). Primary and secondary outcomes include key clinical and microbiological criteria.ResultsThe preliminary findings of the study are found to be promising. After ensuring M.leprae growth in mouse footpad model in mouse after 8 months, it has been found that there is approximately one log decrease in the grown in BALB/C mice after 4 months of treatment with bedaquiline 25 mg/kg once a month. There was no change found in pharmacokinetic profile of bedaquiline, clofazimine and rifampicin when administered altogether as revealed by drug interaction studies. Ten patients have been randomized to each of the treatment arms and are on follow up for observation of outcomes.ConclusionIn conclusion, the initial findings support the potential of the bedaquiline-based regimen in addressing non-responsive multibacillary leprosy cases with minimal evidence of significant pharmacokinetic drug interaction. The findings warrant further exploration.DisclosuresAll Authors: No reported disclosures

Leprosy is a chronic granulomatous disease of the skin, peripheral nerves, and mucosal membranes caused by Mycobacterium leprae. Although curable with multidrug therapy (MDT), relapse, reinfection, or immunologic reactions can occur. Leprosy reactions are abnormal immune responses ranging from type IV hypersensitivity to immune-complex–mediated phenomena, such as erythema nodosum leprosum (ENL). We report a 23-year-old man who completed MDT for multibacillary leprosy 1 year prior and presented with a 2-week history of tender, erythematous subcutaneous nodules, systemic symptoms, and pre-existing hypopigmented patches. Imaging revealed lymphadenopathy and splenomegaly, suggesting systemic inflammation. Biopsies showed granulomatous collections of epithelioid to foamy histiocytes centered on dermal nerve bundles and adnexal structures, with focal early vasculitic changes and scattered neutrophils. Fite-Faraco staining demonstrated numerous weakly acid-fast bacilli. These findings were consistent with leprosy relapse and concurrent ENL. Treatment was initiated with monthly rifampin, moxifloxacin, and minocycline (RMM), alongside methotrexate and prednisone. This case highlights an unusual presentation of leprosy relapse with concurrent ENL following completion of MDT. Ongoing surveillance and follow-up are essential to monitor for relapse, reinfection, and reactions, particularly in high-risk patients.

In the Tiruvallur district of Tamil Nadu State, Annual new case detection rate (ANCDR remained static and has been above State or National levels since 2011. In the absence of district-specific analysis for action, we described the distribution of ANCDR by time, place, and person during 2017-2022. Materials and Methods: Data extracted on age, gender, community, type of leprosy, deformity, and mode of detection of new cases from program registers for fiscal years 2017-2022. ANCDR calculated and computed by type of leprosy, grade 2 deformity (per million), and mode of detection. During 2017-2022, new 842 cases reported. ANCDR ranged from 7.6 (2017-2018) to 5.5 (2021-2022) and was more in three border sub-districts, rural areas, among tribal population, males and those aged 16-60 years. Multibacillary leprosy was more among rural population, males and 16-60 years age group, whereas, paucibacillary was more in urban, females and <15 years age group. Detection by active search was more in urban, tribals, young children, and females. Self-reporting was predominant among the rural population. Grade 2 deformity (per million) was more in urban, among tribals, 16-60 years age group and males. Detection among case contacts through surveys remained low across years. Five-year district-level NLEP data indicated fluctuating ANCDR, poor detection through contact tracing, and higher rates in males, the 16-60 age group, and rural and tribal populations.

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It remains a major public health problem and is often neglected, especially in remote communities. Objective: This case report describes a patient with late detection of multibacillary leprosy who presented with advanced deformity, and highlights the factors contributing to delayed diagnosis. Methods: A clinical assessment and detailed history were conducted on a 78-year-old man from the Orang Asli community in Pekan, Pahang. The diagnosis was made clinically and later confirmed through a skin slit smear with acid-fast staining. Disability grading was performed according to the World Health Organization criteria. Results: The patient presented with a left claw hand deformity that had progressed for two years without treatment, accompanied by ulceration and sensory loss. He was classified as having grade 2 deformity. Multidrug therapy (MDT) was started promptly at the primary care clinic, and his symptoms improved after treatment initiation. Stigma and low awareness of leprosy were identified as the main factors contributing to the delay in seeking care. Conclusion: This case illustrates the consequences of late detection of leprosy, which can lead to permanent disability. Early recognition and prompt initiation of MDT remain essential to prevent progression and reduce disability, especially in underserved communities.

Introduction: Leprosy is a persistent infectious illness which still persists in certain pockets of high endemicity in India. Many of these patients end up with complications with deformities and reactions reporting to our tertiary healthcare center. Aims and Objectives: To analyze the clinical trends of Hansen’s disease over a decade in a tertiary healthcare center in Bengaluru. Materials and Methods: A retrospective record-based study was conducted on leprosy patients registered in our department of dermatology in Bengaluru over a decade, starting from April 2013 to November 2023. Results: A total of 311 cases were registered in the last decade, out of which 73.3% were immigrants. The highest number of cases was among those aged 20–29 years. Childhood leprosy cases constituted 4.1% of total cases. Males exceeded females by 273 (87.7%). The highest cases (16.39%) were noted in 2016 with 51 patients. Multibacillary leprosy constituted 287 (92.28%), among which lepromatous leprosy was the most common presentation. Deformities were seen in 219 (70.4%) patients, with Grade 1 deformity in 158 (50.8%) and claw hand being the most common Grade 2 deformity. There were 22 (7.07%) patients who experienced a reaction; type 2 reactions are more frequent than type 1 reactions. Conclusion: Over the years, our tertiary health center has seen a consistent number of leprosy cases. However, a significant drop in cases was noted in 2020–2021, probably owing to the pandemic and lockdown restrictions. Strikingly, 73% of our patients were immigrants, hailing from West Bengal, Bihar, Orissa, and Andhra Pradesh. This indicates the need for policy makers to focus on the areas of active transmission in the era of eradication of leprosy.

Herpes zoster (HZ) is a reactivation of the varicella zoster virus (VZV). Low immunity, whether due to advanced age, immunosuppressants such as corticosteroids, or chronic infectious conditions such as Morbus Hansen (MH), is the primary predisposing factor for VZV reactivation. A 48-year-old man, previously diagnosed with Morbus Hansen, presented with a painful, burning, erythematous rash that began 5 days before presentation, followed by the development of grouped, fluid-filled blisters on the left waist, some of which ruptured and formed crusts. In the TZANK test, multinucleated giant cells were identified. The patient was given acyclovir, gabapentin, and mupirocin ointment. Leprosy therapy was continued, but corticosteroids were temporarily discontinued until the HZ lesions improved. After 1 week, improvements were observed in the lesions. Adequate therapy is crucial to prevent severe complications in immunocompromised patients. Clinicians should be aware of the potential for this dual disorder, particularly in immunocompromised patients, to promptly identify and manage this condition, thereby minimizing nerve damage, improving patient outcomes, and preventing disability. This case also underscores the need for careful neurological assessment and tailored strategies and therapies in patients with complex infectious neuropathies.