A 35-year-old farmer from a mountainous region presents to a dermatology clinic with multiple skin lesions that have been gradually increasing in size and number over the past two years. He describes areas of numbness and tingling in his arms and legs, along with muscle weakness in his hands. He has no history of fever or systemic illness but reports that his symptoms have progressively worsened.

On examination, the patient has several asymmetrically distributed, hypopigmented and erythematous plaques with poorly defined borders, some of which show partial loss of sensation. There is noticeable thickening of the right ulnar and left common peroneal nerves, with tenderness on palpation. His eyebrows appear sparse, and there is mild clawing of his right hand.

A slit-skin smear reveals a moderate number of acid-fast bacilli, and a skin biopsy shows both tuberculoid granulomas and foamy histiocytes, confirming borderline (dimorphous) leprosy. Given the unstable nature of the disease, the patient is started on multidrug therapy (MDT) with rifampicin, dapsone, and clofazimine for at least 12 months. He is counseled on the risk of disease progression or reversal reactions and referred for nerve function assessment to prevent further disability. Contact tracing is initiated to screen his close contacts for leprosy.