Autochthonous Leprosy in the United States

   This Correspondence presents six cases of autochthonous leprosy locally acquired leprosy diagnosed in U.S.-born men in California between 2017 and 2022. Patients had no known exposure to infected individuals, and only one reported armadillo contact decades earlier. All reported travel mostly domestic visits to the Gulf Coast and international destinations. Clinical and histopathological features were consistent with borderline lepromatous or lepromatous leprosy, confirmed by PCR for M. leprae. All patients received multidrug therapy, but five developed disabilities. The cohort was older (mean age 68.3 years), with all six cases classified as multibacillary. The report highlights delayed diagnosis due to atypical demographic patterns, raises questions about immunosenescence and CD8+ T-cell dysregulation in older patients, and notes the male predominance seen globally. Authors urge U.S. clinicians to recognize leprosy in patients without traditional risk factors to facilitate early treatment and disability prevention.

   This Correspondence presents six cases of autochthonous leprosy locally acquired leprosy diagnosed in U.S.-born men in California between 2017 and 2022. Patients had no known exposure to infected individuals, and only one reported armadillo contact decades earlier. All reported travel mostly domestic visits to the Gulf Coast and international destinations. Clinical and histopathological features were consistent with borderline lepromatous or lepromatous leprosy, confirmed by PCR for M. leprae. All patients received multidrug therapy, but five developed disabilities. The cohort was older (mean age 68.3 years), with all six cases classified as multibacillary. The report highlights delayed diagnosis due to atypical demographic patterns, raises questions about immunosenescence and CD8+ T-cell dysregulation in older patients, and notes the male predominance seen globally. Authors urge U.S. clinicians to recognize leprosy in patients without traditional risk factors to facilitate early treatment and disability prevention.