A Case of Zoonotic Leprosy in West Virginia

INTRODUCTION Leprosy, caused by the acid-fast bacillus Mycobacterium leprae, is a chronic infectious disease that primarily affects skin and peripheral nerves. While it is now considered a rare disorder, nine-banded armadillos recently emerged as a source of zoonotic leprosy in the southern United States (US). We present a patient with zoonotic leprosy diagnosed in West Virginia (WV). An immunocompetent 64-year-old woman, living in WV since late childhood, presented with a one-year history of progressively worsening maculopapular rash and peripheral neuropathy. Skin biopsies from her upper back on two separate occasions revealed well-formed, non-caseating epithelioid granulomas and scarce acid-fast bacilli. The patient had traveled to her son's farmhouse in rural Texas multiple times over the past three years and disclosed seeing several armadillos around the yard. She was diagnosed with tuberculoid leprosy and responded well to dapsone and rifampin. Leprosy is an underrecognized and underdiagnosed disease. Within the last decade, two armadillo- related strains of Mycobacterium leprae have been identified, Awareness of zoonotic leprosy is important for prompt diagnosis and treatment to minimize disability.