Background: Leprosy is a chronic granulomatous infection that affects skin and peripheral nerves. Its prevalence has declined, but is still observed mainly in poor rural areas. Case report: A male city dweller with photophobia and chronic dermatosis in the face: nodular and erythematous lesions, pustules, keratitis and entropion, partial eyebrows loss, and edema on eyelids, chin, and nose bridge. The rest of the body had no lesion or lymphadenopathy. Biopsy revealed Langhans giant cell proliferation in the superficial dermis without epidermal atrophy. BAAR staining for detection were positive, no Virschow cells were observed, and Fite-Franco staining (leprosy-specific) was negative. Cutaneous tuberculosis was diagnosed. Rifampicin/isoniazid/pyrazinamide and dialysate leukocyte extract were prescribed. A month later, the swelling had decreased significantly. Polymerase chain reaction (PCR) test was positive for Mycobacterium leprae. Flow cytometry showed CD4 count normalization. Long-term treatment with rifampicin, clofazimine, and dapsone was established. Conclusions: The host’s immune response determines the clinical features of the disease: if response is bad there will be vacuolated macrophages filled with bacilli (lepromatous leprosy). Clinical and histopathological findings help typing.