A retrospective review of leprosy diagnosed histopathologically from skin biopsy specimens in central South Africa

Abstract

Background: Leprosy, caused by Mycobacterium leprae, remains a condition designated by the World Health Organization (WHO) as a neglected tropical disease, despite formal eradication in South Africa. Histopathology is pivotal in the diagnosis of leprosy, particularly in resource-limited settings.
Objectives: The study aimed to describe the histopathological spectrum and clinical features of leprosy diagnosed on skin biopsies over a 10-year period in central South Africa.
Method: A retrospective review was performed of histologically confirmed leprosy cases diagnosed from January 2015 to December 2024. Data were extracted from laboratory records and analysed descriptively.
Results: Twelve patients were included (mean age 43.9 years, range 25 years – 64 years; male-to-female ratio 1.4:1). Most resided in the Mangaung Metropolitan area, with additional cases dispersed across the Free State and Northern Cape provinces. Punch biopsies predominated, most commonly obtained from the head and/or neck and the upper limbs. World Health Organization classification identified 62% of cases as multibacillary (MB). Ridley-Jopling (RJ) subtypes were mostly lepromatous leprosy (38%), while 23% of cases were indeterminate. Repeat biopsies revealed treatment response or persistent disease. Comorbidities included HIV and tuberculosis.
Conclusion: Leprosy persists as a sporadic but geographically widespread disease in central South Africa, often presenting in advanced MB forms. Histopathology remains essential for diagnosis and subtyping. Strengthening clinician awareness, biopsy protocols, and treatment continuity is critical to achieving the goal of zero leprosy of the WHO.
Contribution: The findings confirm that, although rare, leprosy still prevails in central South Africa. Therefore, clinicians and anatomical pathologists should consider a diagnosis of leprosy in patients with atypical or non-resolving signs and symptoms.