fibrous dysplasia of bone is characterized by the replacement of medullary bone with fibro - osseous tissue . this results in the distortion and overgrowth of bone , leading to characteristic deformities . based on the bony involvement , fibrous dysplasia is divided into three types : monostotic , polyostotic , and mccune  albright syndrome ( mas ) . mas is characterized by a triad of monostotic / polyostotic fibrous dysplasia , caf-au - lait macules ( calms ) , and endocrine hyperfunction . the disease is congenital but not hereditary and is due to an activating mutation in g protein - coupled receptor . it manifests usually in childhood , with recurrent fractures , distorted bones , precocious puberty , acromegaly , or hyperthyroidism . untreated disease leads to permanent disfigurement , and the disease is classified as paucibacillary or multibacillary depending on the proliferation of the bacilli . the risk factors for the disease are living in endemic areas with poor hygiene conditions and defects in cell - mediated immunity . we recently encountered a patient with mas who presented with cutaneous features of hansen 's disease . we report the same for the unusual association and to highlight the relevant review of the literature . a 30-year - old man presented with hypoesthetic , depigmented patches over the skin of the chest and back of 1 year duration . he gave history of recurrent fractures since the age of 4 years with shortening of right leg . the parents gave history of hyperpigmented macules over the trunk since birth and denied similar features in family members . the patient attained puberty at the age of 14 years and denies history suggestive of acral enlargement , thyrotoxicosis , cushing 's syndrome , and swellings in any part of the body . examination revealed ( height 152 cm ) asymmetry of the face with expansion of right maxilla and lower jaw and short right leg ( 82 vs 86 cm ) [ figures 1 and 2 ] . cutaneous examination revealed a large calm over the back , extending across the midline and multiple anesthetic patches over scapula and lower back [ figure 3 ] . there was no evidence of goiter , acromegaloid features , and thickened nerves , and the rest of the examination was normal . facial photograph showing craniofacial dysplasia legs showing short right leg ( arrow ) with expansile lesion of tibia ( arrow head ) skin over the back showing a large calm crossing midline ( long arrows ) with depigmented hypoesthetic patches ( short arrow ) hormonal profile revealed normal thyroid adrenal and gonadal axes evaluation . skeletal survey revealed expansile osteolytic lesion over right maxilla , right hip , and shoulder . skin biopsy specimens were obtained from ear lobes , legs , and depigmented lesions over the back , avoiding areas of calm . specimens revealed the presence of acid - fast bacilli along with noncaseating granulomas consistent with the diagnosis of tuberculoid leprosy . the diagnosis of fibrous dysplasia is made by the presence of bone pains , recurrent fractures , deformity of bone , and radiological evidence of fibro - osseous tissue showing expansile lytic lesion . biopsy and tc - mdp scan of the bone were not considered necessary to establish the diagnosis in this classical case . other laboratory workup showed elevated alkaline phosphatase ( 388 u / l ) with normal calcium , phosphorus , parathyroid hormone , and 25-hydroxy vitamin d levels . he was treated with triple drug regimen for leprosy and also given oral calcium carbonate 1.5 g daily along with the first dose of zoledronic acid 4 mg as an intravenous infusion . mas is characterized by the triad of polyostotic fibrous dysplasia , calm , and endocrinopathy . the diagnosis of fibrous dysplasia is based on classical radiological findings supported by histopathology and bone scan . hyperfunctioning of endocrine glands in mas presents with precocious puberty , hyperthyroidism , acromegaly , or cushing 's syndrome . our patient had only two features of the triad and did not have any evidence of endocrine hyperfunction syndromes . the calm is unusual in our patient in that it crossed the midline and was seen on both sides of the body . the calms in mas do not cross the midline and follow the developmental lines of blashko , thus differentiating from those in neurofibromatosis . our patient had an exceptionally large calm that crossed the midline interspersed with anesthetic depigmented macular lesions of hansen 's disease . hansen 's disease is caused by mycobacterium leprae , and the disease spreads via respiratory droplets between close personal contacts over a prolonged duration . immunocompromised situations are the predominant risk factors for the disease , and defects in cell - mediated immunity are implicated in persons with genetic predisposition . the mode of acquisition of hansen 's disease in our patient is possibly due to frequent stay in the hospitals due to multiple fractures and contact with a patient . screening of the persons involved in personal care of the patient did not reveal features of hansen 's disease . the association of hansen 's disease with mas appears coincidental as there is no evidence that mas predisposes to the infectious diseases or leads to immunosuppressed state . extensive literature search did not reveal any previous reports of association between hansen 's disease and mas . they are given as intravenous or oral preparation and act by suppressing the osteoclast activation . treatment of mas involves bisphosphonate therapy to reduce fracture rate apart from treating any associated endocrinopathy . to conclude , we present an interesting case of mas without associated endocrinopathy who had coexisting hansen 's disease . this unusual combination was not reported earlier in world literature .