Treatment neglect in multibacillary leprosy leading to osteomyelitis and transtibial amputation: Lessons from endemic setting

Leprosy, caused by the Mycobacterium leprae complex, remains an important cause of preventable disability, particularly in endemic countries. Multibacillary disease, when left untreated, may progress rapidly to severe neuropathy, secondary infection, and irreversible tissue damage. We report a 66-year-old man who presented with multiple infected ulcers of the right foot, ankle, and lower leg, complicated by acute osteomyelitis, ultimately requiring transtibial amputation. The patient had a 2-year history of untreated anesthetic skin lesions after declining referral and did not receive antileprosy therapy during that period. Clinical examination revealed diffuse anesthetic patches, peripheral neuropathy with claw-hand deformities, and features consistent with advanced multibacillary leprosy. Slit-skin smear and histopathology supported a lepromatous spectrum of disease. Multibacillary multidrug therapy was initiated; dapsone was temporarily withheld because of anemia, and rifampicin with clofazimine was administered. Despite antimicrobial therapy and wound management, the extent of infection necessitated surgical amputation to control disease progression. This case highlights the consequences of treatment neglect in multibacillary leprosy and underscores the importance of early therapeutic intervention, continuous care, and patient adherence to prevent severe disability in endemic settings.