When a mimicker is mimicked: A case report on acid-fast atypical lepromatous leprosy mimicking tuberculosis.

Leprosy is caused by Mycobacterium leprae, may mimic tuberculosis. We describe a 22 year old woman with prolonged fever and cervical and inguinal lymphadenopathy. Initial lymph node aspirate from an outside centre showed acid fast bacilli (AFB) on ZN staining using 20% sulfuric acid, leading to a diagnosis of tuberculosis and initiation of anti-tubercular therapy. Additionally, she developed ulcerative lesions over the feet after six weeks. At our centre, lesion pus revealed abundant AFB with differential decolorization. CBNAAT for tuberculosis was negative. Slit-skin smears, Fite Faraco stain and PCR confirmed multibacillary leprosy erythema nodosum leprosum. Multidrug therapy resulted in clinical improvement, highlighting diagnostic challenges.