Case Report Multibacillary Leprosy Presenting as Anetoderma in a Young Teenager Niraj Parajuli , 1 Shraddha Shrestha, 1 Laila Lama, 1 Rushma Shrestha, 1 Sumida Tiwari, 2 and Anupama Karki 1 1 Department of Dermatology & Venereology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal 2 Department of Pathology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal Correspondence should be addressed to Niraj Parajuli; drnirajparajuli@gmail.com Received 23 May 2020; Accepted 17 July 2020; Published 29 July 2020 Academic Editor: Jacek Cezary Szepietowski Copyright©2020NirajParajulietal.isisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Anetodermapresentsasacircumscribedareaofslackskin.Itcanpresentaseitherprimaryorsecondary,ifassociatedwithother conditions. Leprosy is one of the causes of secondary anetoderma, but it is not commonly reported, especially in multibacillary leprosy. Here, we report a case of a 16-year-old young girl who presented with fever, joint pain, and only three anetodermic plaques. A slit skin smear from the lesion showed multiple acid-fast bacilli with a bacillary index of 3+, thus confirming the diagnosis of leprosy. is case is unique since multibacillary leprosy presented with only few anetoderma lesions in a young teenager girl from a leprosy-eliminated country. 1. Introduction Anetoderma refers to a circumscribed area of slack skin associated with a loss of dermal substance on palpation andalossofelastictissueonhistologicalexamination[1]. Anetoderma is an elastolytic disorder characterized by localized areas of flaccid skin, which may be depressed, macular, or papular [2]. “Primary” anetoderma is asso- ciated with no localized underlying cutaneous disease, whereas “secondary” anetoderma can be attributed to some associated condition like leprosy, tuberculosis, ur- ticaria pigmentosa, pityriasis versicolor, granuloma annulare, and others [1]. Here, we report a case of multibacillary leprosy pre- senting as anetoderma in a young teenager girl during the post-elimination era. 2. Case Report A 16-year-old female from the Terai region presented to theemergencydepartmentwithcomplaintsofhigh-grade fever for 5 days. She was being managed empirically with parenteral antibiotics. An opinion was sought from the dermatological team regarding few asymptomatic, skin- coloredlesionsovertheextremities.esoftplaqueswere firstnoticedovertheleftlowerlegand,then,overtheright armwithinaperiodof6months.erewasnosignificant past and family history. On general examination, an ill-looking young female with fever, bilateral pedal pitting edema, and diffuse swelling of the face was observed. Vital signs were all withinnormallimits.Onskinexamination,fewround-to- oval plaques with an atrophic, wrinkled surface of ap- proximate 1 × 1cm 2 were present over the right arm, forearm, and left lower leg. On stretching, atrophic pla- quesbecameflat(Figure1(a)),andonleavingtheskinlax, the plaques returned to initial texture (Figure 1(b)).Similar plaques were also present over the left lower thigh (Figure 2). All the plaques had decreased sensationtocoldandtouch.Bilateralulnarnervesandthe leftcommonperonealnervewereenlargedandtender.No motor deficit or deformity was noted during the exami- nation. A slit skin smear with Ziehl–Neelsen stain was performed, revealing multiple acid-fast bacilli with a bacillary index (BI) of 3+. Excisional biopsy and histo- pathological examination of atrophic plaques from the Hindawi Case Reports in Dermatological Medicine Volume 2020, Article ID 8847310, 3 pages https://doi.org/10.1155/2020/8847310