A Case of Lepromatous Leprosy Presenting With Multiple Morphologies in Philadelphia

Leprosy is an uncommon chronic mycobacterial infection in the United States caused by <i>Mycobacterium leprae</i>. There are two major forms of the infection, lepromatous leprosy and tuberculoid leprosy, with borderline forms of each. Leprosy is even more uncommon in the Northeastern United States and can present with various symptoms and skin findings, including erythematous or hypopigmented patches or plaques with accompanying hypoesthesia or anesthesia, anhidrosis, or alopecia. We present the case of a 29-year-old woman with a progressive rash with multiple morphologies accompanied by neuropathy and pain. Skin biopsy demonstrated acid-fast bacilli, and a diagnosis of lepromatous leprosy was confirmed. With leprosy cases on the rise, it is paramount that clinicians consider this diagnosis so that prompt treatment can be initiated. This case provides a clinical example of multiple morphologies of leprosy infection in a clinical setting where the prevalence of leprosy is very low.