Atypical orbital cellulitis in a leprosy patient –A diagnostic and therapeutic challenge

Leprosy is primarily a disease of the skin and peripheral nerves; its association with malignancies in atypical sites like the orbit is exceedingly rare. The diagnostic challenge arises from overlapping clinical features of leprosy-induced inflammation and malignancy, often leading to delays in diagnosis and treatment. We present the case of a male in his fifties with a history of treated leprosy who presented with progressive proptosis, orbital swelling, and a frozen globe. Initial evaluation suggested orbital cellulitis or granulomatous inflammation secondary to residual leprosy. Imaging revealed poorly demarcated orbital mass involving the extraocular muscles and optic nerve, raising suspicion for malignancy. Histopathological examination of the orbital biopsy confirmed a diagnosis of T-cell lymphoma.