Leprosy masquerading as facial cellulitis

Leprosy is a chronic granulomatous infection generally caused by Mycobacterium leprae and Mycobacterium lepromatosis , which primarily affect the skin and peripheral nerves. A 42-year-old female patient, a resident of Punjab, presented with complaints of recurrent swelling and redness over their chin and left half of their face from 5 years duration. There was no history of fever with episodes of swelling. Every time she was diagnosed with facial cellulitis and was treated with antibiotics orally and intravenously, only to have partial remission. Examination revealed ill-defined, erythematous, indurated swelling with irregular margins over the left cheek, left the periocular area, chin, and submental area giving peau d orange appearance. Based upon the chronic duration, and treatment history a differential of borderline leprosy in type 1 reaction was kept and further detailed examination was done. Histopathological examination gave the impression of borderline tuberculoid Hansen. Based on the clinical picture, history, and histopathology, diagnosis of borderline tuberculoid leprosy was made. The patient was then started on MBMDT pack.