The earliest recorded case of lepromatous leprosy in continental Croatia

Among 89 skulls from the Bijelo Brdo site in mainland Croatia dated between the 10th and 11th centuries, two show osteological features characteristic for lepromatous leprosy. Both skulls have female traits. An adult individual exhibits inflammatory changes on the palatine process, the alveolar process of the maxilla, the inferior nasal aperture, and on the anterior nasal spine. A younger individual, between 15 and 17 years at the time of death, exhibits less pronounced changes on the inferior nasal aperture, and the anterior nasal spine. Differential diagnosis excluded fungal infections (aspergillosis, mucormycosis), bacterial infections (actinomycosis, tuberculosis), and granulomatous disorders (sarcoidosis, and treponemal diseases). Molecular genetic analysis targeting the repetitive elements RLEP (37 copies/cell) and RepLep (15 copies/cell) of the M. leprae genome confirmed the presence of the disease in the adult individual. The possible geography of the spread of this infectious disease in Croatia is discussed.