Mycobacterium leprae (M leprae), the causative agent of Hansen's disease, is endemic in many areas of Asia, sub-Saharan Africa, South and Central America, the Pacific Islands, and the Philippines. The spectrum of clinical disease is dependent on the patient's cell-mediated immunity and might range from localized anesthetic patches or plaques to disseminated disease. If undiagnosed, progression with damage to the involved sensory and motor nerves might occur. Lepromatous vasculitis occurs most commonly in patients with severe disseminated disease. Vascular disease, as the initial presenting sign of tuberculoid leprosy, is, however, rare. We present one patient in whom the development of Hansen's disease was associated with involvement of the external jugular vein and was initially seen as external jugular vein fibrosis.