Atypical cutaneous lesion mimicking connective tissue nevus in a case of lepromatous leprosy

Atypical skin lesions in leprosy sometimes mimic other dermatological diseases. Here, we report a case of lepromatous leprosy with connective tissue nevus-like cutaneous lesions. A 29-year-old male presented with numbness and burning sensation on the soles of the feet for 8 months. On examination, there were clinical features of lepromatous leprosy, which were supported by slit skin smear and biopsy. Over the right posterior shoulder, erythematous, soft, non-tender papules coalescing to form a linear plaque were present. Our provisional clinical diagnosis based on the morphology of the lesions was connective tissue nevus or nevus lipomatous superficalis. However, a slit skin smear and biopsy findings were suggestive of lepromatous leprosy. This case highlights the importance of a high index of suspicion, especially in endemic areas and the importance of the slit skin smear and biopsy in diagnosing leprosy.