A Rare Combination of Pure Neuritic Leprosy with Morphea Leading to Diagnostic Confusion.

Abstract

A circumscribed sclerotic plaque of morphea can sometimes be mistaken for tuberculoid leprosy and vice versa can also happen. However, the co-existence of a patch of morphea mimicking as Leprosy patch in an underlying case of neuriticleprosy, can be very misleading. We present a case with glove and stocking anaesthesia and peripheral nerve enlargement with a single large hypopigmented, non-anaesthetic macule on trunk, clinically diagnosed as Hansen's disease (Borderline Tuberculoid - BT). Slit skin smears proved to be negative for AFB and histopathology of the skin lesion was consistent with morphea, which lead us to do a nerve biopsy. Sural nerve biopsy proved it to be Hansen's neuritis with occasional bacilli. The patient was started on MDT-MB and followed up. This is a rare case of co-existing morphea with Hansen's disease. It would have been easily misclassified if we had presumed the cutaneous lesion to be a case of Hansen's (BT) patch and not done a cutaneous nerve biopsy which led to diagnosis of multibacillary leprosy.