BACKGROUND: Leprosy is a chronic granulomatous infection caused by Mycobacterium 
leprae. It is a polymorphic disease with a wide range of cutaneous and neural 
manifestations. Ulcer is not a common feature in leprosy patients, except during 
reactional states, Lucio's phenomenon (LP), or secondary to neuropathies.
CASES PRESENTATION: We report eight patients with multibacillary leprosy who 
presented specific skin ulcers as part of their main leprosy manifestation. 
Ulcers were mostly present on lower limbs (eight patients), followed by the 
upper limbs (three patients), and the abdomen (one patient). Mean time from 
onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were 
either misdiagnosed or had delayed diagnosis, with seven of them presenting 
grade 2 disability by the time of the diagnosis. Reactional states, LP or 
neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was 
available in seven patients: histopathology showed mild to moderate 
lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated 
and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of 
chronic venous insufficiency were not observed. Skin lesions improved rapidly 
after multidrug therapy, without any concomitant specific treatment for ulcers.
CONCLUSIONS: This series of cases highlights the importance of recognizing 
ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and 
treatment of the disease, and therefore avoiding development of disabilities and 
persistence of the transmission chain of M. leprae.