Rare Masqueraders of Pure Neuritic Leprosy: A Report of Four Cases.

Introduction: Hansen's disease is a chronic, infective granulomatous skin disease with a wide array of manifestations that resemble many dermatological and neurological conditions. Pure neuritic Hansen's disease is a familiar form among leprosy physicians, and it poses significant diagnostic difficulty. Various disorders can mimic leprosy neuropathy clinically and these patients may receive multidrug therapy in endemic areas due to the commonality of leprosy. Hence, it is necessary to be aware of mimickers of leprosy in its various forms.

Patients and methods: We conducted a single-center retrospective analysis from January 2022 to June 2023. We reviewed clinical, radiological, and histopathological findings of the patients referred from neurology outpatient department which mimicked leprosy neuropathy.

Results: We are presenting four such patients with symptoms related to neuropathy and disability. The slit skin smear was negative in all these patients, and ultrasonography, magnetic resonance imaging, and histopathology were done for diagnostic confirmation. Ultimately, all these patients were concluded to be non-leprosy cases, and an alternative diagnosis was made.

Conclusion: Leprosy can appear in various patterns and can be mistaken for other dermatoses. Since leprosy still carries a social stigma attached to it, a wide range of dermatological and neurological illnesses must be ruled out in the differential diagnosis. These four rare entities can also mimic pure neuritic leprosy, and a thorough neurocutaneous examination complemented with appropriate radiological investigations is key to diagnosing these conditions.