Major risk factors for leprosy in a non-endemic area of the United States: A case series

Approximately 200 cases of leprosy are reported each year in the United States, and about 175 of the cases are diagnosed for the first time. Florida contributes a large number of reported cases each year and is showing an increasing incidence. Studies from other southern U.S. states demonstrate infection with the same strain of Mycobacterium leprae, confirming human armadillo exposure as the main risk factor. In contrast, cases from Florida show no clear risk factor. We present three cases (two foreign born and one autochthonous case) from Hillsborough county Florida, that were reported from this non-endemic area during the past five years. The first case was a 35-year-old male from Mexico, with history of exposure from a Haitian inmate, who presented with multiple erythematous non-tender cutaneous lesions and numbness in both hands. Biopsy confirmed borderline lepromatous leprosy. The second case was a 34-year-old male, from Florida who presented with sparse annular non-supporative lesions on left cheek with one-month duration and denied leprosy or armadillo exposure. Biopsy confirmed the diagnosis of borderline tuberculoid leprosy. The third case was a 38-year-old female, from Puerto Rico who presented with disseminated painless plaques, edema of the hands with numbness and paresthesia. She denied leprosy or armadillo exposure. The biopsy confirmed borderline lepromatous leprosy with erythema nodosum leprosum. Our case series demonstrates that a history of armadillo exposure is not always present. Other risk factors need to be considered when leprosy is a possible diagnosis in a patient.