Leprosy, also known as Hansen disease, is an uncommon chronic disease caused by the slowly growing acid-fast bacilli, Mycobacterium leprae. Leprosy has tropism for peripheral nerves and skin and can also be found in the upper respiratory tract, eyes, and nasal mucosa. When left untreated, there can be considerable nerve damage resulting in paralysis, blindness, and the crippling of hands and feet. Although infrequent in the United States, leprosy has been diagnosed in patients exposed to armadillos, an animal reservoir. We describe an 80-year-old man who presented with a 6-year history of chronic erythematous, macular rash, and progressive symmetric sensory motor neuropathy. Initially, it was thought that the patient had an eczematous rash; however, he was later diagnosed with polar lepromatous disease owing to findings from a sural nerve biopsy. When results of clinical examination and skin biopsy are inconclusive, use of a peripheral nerve biopsy may help confirm leprosy.

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