{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:58:16Z","timestamp":1791003496628,"version":"4.1.0"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease.<\/jats:p>","DOI":"10.1093\/trstmh\/trad003","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T09:18:52Z","timestamp":1677489532000},"page":"489-495","source":"Crossref","is-referenced-by-count":6,"title":["Unusual clinical presentations in leprosy: a case series and review"],"prefix":"10.1093","volume":"117","author":[{"given":"Gitesh Upendra","family":"Sawatkar","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"},{"name":"Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences , Nagpur, 441108 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9495-7502","authenticated-orcid":false,"given":"Apoorva","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Keshavamurthy","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitaishi","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debajyoti","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Histopathology; Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0464-2989","authenticated-orcid":false,"given":"Tarun","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9912-0085","authenticated-orcid":false,"given":"Sunil","family":"Dogra","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research , Chandigarh, 160012 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"2023070411502278100_bib1","first-page":"421","author":"World Health Organization","year":"2021","journal-title":"WHO | Weekly Epidemiological Record, No. 36"},{"issue":"4","key":"2023070411502278100_bib2","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1097\/DAD.0000000000000698","article-title":"Borderline tuberculoid leprosy masquerading as granuloma annulare: a clinical and histological pitfall","volume":"39","author":"Zhu","year":"2017","journal-title":"Am J Dermatopathol"},{"issue":"32","key":"2023070411502278100_bib3","doi-asserted-by":"crossref","first-page":"e11616","DOI":"10.1097\/MD.0000000000011616","article-title":"Borderline tuberculoid leprosy mimicking sarcoidosis: a case report","volume":"97","author":"Liu","year":"2018","journal-title":"Medicine"},{"key":"2023070411502278100_bib4","first-page":"269","article-title":"Affection of immune zones in leprosy: a clinico-epidemiological study","volume":"78","author":"Rajashekar","year":"2006","journal-title":"Indian J Lepr"},{"issue":"4","key":"2023070411502278100_bib5","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.4269\/ajtmh.19-0598","article-title":"Palmoplantar involvement in leprosy: a clinicopathological study","volume":"104","author":"Dabas","year":"2021","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"2023070411502278100_bib6","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/ijd.14274","article-title":"Mid borderline leprosy in type B\u03b1 blaschko linear pattern: a rare phenomenon","volume":"58","author":"Chetan","year":"2019","journal-title":"Int J Dermatol"},{"issue":"6","key":"2023070411502278100_bib7","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1111\/ijd.14439","article-title":"Borderline lepromatous leprosy masking as tinea versicolor","volume":"58","author":"Day","year":"2019","journal-title":"Int J Dermatol"},{"issue":"4","key":"2023070411502278100_bib8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5070\/D365H88318","article-title":"A case of leprosy disease presenting as tinea versicolor","volume":"19","author":"Yang","year":"2013","journal-title":"Dermatol Online J"},{"issue":"1","key":"2023070411502278100_bib9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1590\/abd1806-4841.20197887","article-title":"Erythroderma as a manifestation of leprosy","volume":"94","author":"Baldissera","year":"2019","journal-title":"An Bras Dermatol"},{"issue":"3","key":"2023070411502278100_bib10","doi-asserted-by":"crossref","first-page":"252","DOI":"10.47276\/lr.84.3.252","article-title":"Deck chair sign in lepromatous leprosy","volume":"84","author":"Prashar","year":"2013","journal-title":"Lepr Rev"},{"issue":"2","key":"2023070411502278100_bib11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.47276\/lr.83.2.202","article-title":"Borderline-lepromatous leprosy manifesting as granulomatous mastitis","volume":"83","author":"Pandhi","year":"2012","journal-title":"Lepr Rev"},{"issue":"4","key":"2023070411502278100_bib12","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1111\/ijd.14783","article-title":"Leprosy pseudoimbricata: an unusual presentation of steroid-modified borderline lepromatous leprosy","volume":"59","author":"Kumar","year":"2020","journal-title":"Int J Dermatol"},{"key":"2023070411502278100_bib13","doi-asserted-by":"crossref","first-page":"57","DOI":"10.4103\/0974-2727.187919","article-title":"Unusual presentation of multibacillary nodular leprosy","volume":"9","author":"Raut","year":"2017","journal-title":"J Lab Physicians"},{"issue":"3","key":"2023070411502278100_bib14","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1590\/abd1806-4841.20142964","article-title":"Verrucous lepromatous leprosy: a rare form of presentation\u2013report on two cases","volume":"89","author":"Medeiros","year":"2014","journal-title":"An Bras Dermatol"},{"key":"2023070411502278100_bib15","doi-asserted-by":"crossref","first-page":"445","DOI":"10.4103\/ijmy.ijmy_168_20","article-title":"Verrucous lesions in leprosy","volume":"9","author":"Ashraf","year":"2020","journal-title":"Int J Mycobacteriol"},{"issue":"7","key":"2023070411502278100_bib16","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1002\/ccr3.2897","article-title":"An unusual case of multibacillary leprosy mimicking prurigo nodularis","volume":"8","author":"Noormohammadpour","year":"2020","journal-title":"Clin Case Rep"},{"issue":"3","key":"2023070411502278100_bib17","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1159\/000510737","article-title":"A case report of prurigo nodularis-like lesions in a patient with lepromatous leprosy","volume":"12","author":"Nawalerspanya","year":"2020","journal-title":"Case Rep Dermatol"},{"key":"2023070411502278100_bib18","first-page":"352","article-title":"Pruritic lesions during pregnancy: an unusual presentation of a rare variant of multibacillary leprosy","volume":"107","author":"S\u00e1nchez-Orta","year":"2016","journal-title":"ActasDermosifiliogr"},{"key":"2023070411502278100_bib19","doi-asserted-by":"crossref","first-page":"176","DOI":"10.4103\/ijdvl.IJDVL_653_17","article-title":"Lepromatous leprosy masquerading as anetoderma in a boy","volume":"86","author":"Razmi","year":"2020","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"2023070411502278100_bib20","first-page":"8847310","article-title":"Multibacillary leprosy presenting as anetoderma in a young teenager","volume":"2020","author":"Parajuli","year":"2020","journal-title":"Case Rep Dermatol Med"},{"key":"2023070411502278100_bib21","first-page":"359","article-title":"Lepromatous leprosy with unusual features resembling adenoma sebaceum","volume":"76","author":"Barman","year":"2004","journal-title":"Indian J Lepr"},{"issue":"2","key":"2023070411502278100_bib22","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/ijd.12237","article-title":"Novel presentation of lepromatous leprosy in an erythema gyratum repens-like pattern","volume":"53","author":"Mohanan","year":"2014","journal-title":"Int J Dermatol"},{"issue":"4","key":"2023070411502278100_bib23","doi-asserted-by":"crossref","first-page":"632","DOI":"10.4103\/idoj.IDOJ_495_19","article-title":"A masquerading solitary skin lesion: unusual presentation of multibacillary leprosy with dermoscopic assistance in diagnosis","volume":"11","author":"Kansal","year":"2020","journal-title":"Indian Dermatol Online J"},{"issue":"5","key":"2023070411502278100_bib24","doi-asserted-by":"crossref","first-page":"957","DOI":"10.4269\/ajtmh.19-0495","article-title":"A \u201crat-bitten\u201d ulcer on the pinna","volume":"101","author":"Kaushik","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"2023070411502278100_bib25","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1186\/s12879-019-4639-2","article-title":"Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases","volume":"19","author":"Miyashiro","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"2","key":"2023070411502278100_bib26","doi-asserted-by":"crossref","first-page":"268","DOI":"10.3126\/kumj.v19i2.49693","article-title":"Isolated leprosy of bilateral ear lobes, a rare presentation of leprosy","volume":"19","author":"Paudel","year":"2021","journal-title":"Kathmandu Univ Med J"},{"key":"2023070411502278100_bib27","first-page":"1815","article-title":"Isolated bilateral pinna swelling: a rare initial presentation of leprosy","volume":"7","author":"Yusuf","year":"2019","journal-title":"J Med Sci"},{"issue":"4","key":"2023070411502278100_bib28","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1177\/0049475520932473","article-title":"Zosteriform multidermatomal nodules and plaques in a case of lepromatous leprosy: an uncommon presentation","volume":"50","author":"Mathachan","year":"2020","journal-title":"Trop Doct"},{"key":"2023070411502278100_bib29","first-page":"ZD19","article-title":"Leprosy in an eight-year-old child - An exceptional case with unusual oral manifestation","volume":"11","author":"Jain","year":"2017","journal-title":"J ClinDiagn Res"},{"issue":"11","key":"2023070411502278100_bib30","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1111\/ijd.13021","article-title":"Unilateral nipple involvement in histoid leprosy","volume":"54","author":"Vinay","year":"2015","journal-title":"Int J Dermatol"},{"key":"2023070411502278100_bib31","first-page":"117","article-title":"Histoid leprosy presenting with keloid like lesions","volume":"88","author":"Nair","year":"2016","journal-title":"Indian J Lepr"},{"issue":"4","key":"2023070411502278100_bib32","doi-asserted-by":"crossref","first-page":"391","DOI":"10.47276\/lr.86.4.391","article-title":"Single patch, mononeuritic multibacillary leprosy: a case report","volume":"86","author":"Arshdeep","year":"2015","journal-title":"Lepr Rev"},{"key":"2023070411502278100_bib33","first-page":"747","article-title":"Leprous polyneuritis cranialis mimicking orbital apex syndrome","volume":"62","author":"Londhey","year":"2014","journal-title":"J Assoc Physicians India"},{"key":"2023070411502278100_bib34","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4103\/ijmy.ijmy_35_17","article-title":"Tenosynovitis: an unusual presentation of leprosy","volume":"6","author":"Baveja","year":"2017","journal-title":"Int J Mycobacteriol"},{"issue":"1","key":"2023070411502278100_bib35","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12895-017-0068-3","article-title":"A case report of erythroderma in a patient with borderline leprosy on reversal reaction: a result of the exacerbated reaction?","volume":"17","author":"Miyashiro","year":"2017","journal-title":"BMC Dermatol"},{"key":"2023070411502278100_bib36","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/j.1468-3083.2006.01439.x","article-title":"Multiple superficial sporotrichoid nerve abscesses with a hyperpigmented lesion in a tuberculoid leprosy patient: a rare and unusual presentation","volume":"20","author":"Ghorpade","year":"2006","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"3","key":"2023070411502278100_bib37","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1590\/abd1806-4841.20164111","article-title":"Type 2 leprosy reaction with Sweet's syndrome-like presentation","volume":"91","author":"Chiaratti","year":"2016","journal-title":"An Bras Dermatol"},{"key":"2023070411502278100_bib38","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1111\/j.1365-4362.1987.tb02293.x","article-title":"Severe reactional state in lepromatous leprosy simulating Sweet's syndrome","volume":"26","author":"Kou","year":"1987","journal-title":"Int J Dermatol"},{"issue":"3","key":"2023070411502278100_bib39","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/ijd.12292","article-title":"Rare atypical presentations in Type 2 lepra reaction: a case series","volume":"53","author":"Vijendran","year":"2014","journal-title":"Int J Dermatol"},{"issue":"1","key":"2023070411502278100_bib40","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4103\/ijmy.ijmy_186_17","article-title":"Reactive perforating leprosy, erythema multiforme-like reactions, sweet's syndrome-like reactions as atypical clinical manifestations of Type 2 leprosy reaction","volume":"7","author":"Gunawan","year":"2018","journal-title":"Int J Mycobacteriol"},{"key":"2023070411502278100_bib41","first-page":"856","article-title":"Reactional state in lepromatous leprosy simulating Sweet's syndrome","volume":"61","author":"Das","year":"2013","journal-title":"J Assoc Physicians India"},{"key":"2023070411502278100_bib42","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4103\/ijmy.ijmy_26_20","article-title":"Late leprosy reaction presenting as erythema multiforme-like erythema nodosum leprosum with underlying rifampicin resistance and its potential implications","volume":"9","author":"Sardana","year":"2020","journal-title":"Int J Mycobacteriol"},{"issue":"3","key":"2023070411502278100_bib43","doi-asserted-by":"crossref","first-page":"201","DOI":"10.47276\/lr.85.3.201","article-title":"Annular bullous lesions with atypical erythema multiforme in leprosy","volume":"85","author":"Shah","year":"2014","journal-title":"Lepr Rev"},{"issue":"10","key":"2023070411502278100_bib44","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1177\/0961203315574557","article-title":"Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review","volume":"24","author":"Horta-Baas","year":"2015","journal-title":"Lupus"},{"issue":"1","key":"2023070411502278100_bib45","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1159\/000462959","article-title":"Extensive lepromatous lymphadenitis preceding lesions on the face and earlobes: an unusual presentation of leprosy in singapore","volume":"10","author":"Yang","year":"2018","journal-title":"Case Rep Dermatol"},{"issue":"3","key":"2023070411502278100_bib46","doi-asserted-by":"crossref","first-page":"310","DOI":"10.47276\/lr.89.3.310","article-title":"Erythema nodosum leprosum (ENL) mimicking pityriasis lichenoides et varioliformacuta (PLEVA): an atypical presentation","volume":"89","author":"Sirka","year":"2018","journal-title":"Lepr Rev"},{"issue":"1","key":"2023070411502278100_bib47","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/rheumatology\/key216","article-title":"Necrotic erythema nodosum leprosum masquerading as cutaneous vasculitis","volume":"58","author":"Bhattacharjee","year":"2019","journal-title":"Rheumatology"},{"issue":"2","key":"2023070411502278100_bib48","doi-asserted-by":"crossref","first-page":"182","DOI":"10.4103\/2229-5178.131097","article-title":"Livedo reticularis in type 2 lepra reaction: a rare presentation","volume":"5","author":"Naveen","year":"2014","journal-title":"Indian Dermatol Online J"},{"key":"2023070411502278100_bib49","first-page":"206","article-title":"Bullous reaction in leprosy: a rare phenomenon","volume":"70","author":"Dogra","year":"2002","journal-title":"Int J Lepr Other Mycobact Dis"},{"issue":"1","key":"2023070411502278100_bib50","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4269\/ajtmh.20-0177","article-title":"Lichenoid skin nodules as presenting feature of necrotic erythema nodosum leprosum in leprosy","volume":"103","author":"Kaushik","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"9","key":"2023070411502278100_bib51","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1111\/ijd.12772","article-title":"Erythema nodosum leprosum on glans penis: unusual manifestation of common disease","volume":"54","author":"Kothiwala","year":"2015","journal-title":"Int J Dermatol"},{"issue":"2","key":"2023070411502278100_bib52","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/ijd.12324","article-title":"Reactive perforating leprosy: pustular erythema nodosum leprosum with epidermal perforation and liberation of Mycobacterium leprae","volume":"53","author":"Ghorpade","year":"2014","journal-title":"Int J Dermatol"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/117\/7\/489\/50796328\/trad003.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/117\/7\/489\/50796328\/trad003.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T14:36:24Z","timestamp":1701873384000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/117\/7\/489\/7058784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,27]]},"references-count":52,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,2,27]]},"published-print":{"date-parts":[[2023,7,4]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trad003","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,7]]},"published":{"date-parts":[[2023,2,27]]}}}