Neuropathy as the only sign of borderline lepromatous leprosy for 13 years

A 57-year-old man experienced numbness in his right hand in 1975 and then noticed weakness and sensory disturbance in his legs. The neurological symptoms were suggestive of a degenerative neural disease, such as Charcot-Marie-Tooth disease. However a diagnosis of leprosy was established because of nerve enlargement and tenderness and after a nerve biopsy. The patient did not have any skin lesions. Treatment was initiated with diaminodiaphenylsulfone (DDS) and discontinued one year later at the patient's request. Various asymmetric eruptions first appeared on his body in 1988. Based on the 5+ average bacterial index of eruptions and the negative lepromin reaction in addition to the clinical pictures, he was diagnosed as having borderline lepromatous leprosy. Our case is a very rare type of borderline lepromatous leprosy in which peripheral neuropathy preceded the onset of skin lesions by 13 years.