Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease predominantly affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract, and the eyes. ¹ The diagnosis of leprosy is based on the presence of at least 1 of 3 cardinal signs: definite loss of sensation in a pale or reddish skin patch, a thickened or enlarged peripheral nerve with loss of sensation, and/or weakness of the muscles supplied by the nerve, and the presence of acid-fast bacilli in a slit-skin smear. However, there are no reports that describe the link between leprosy and pulmonary hypertension (PH). Here, we describe a 22-year-old man who was first diagnosed with leprosy and subsequently developed PH, confirmed by echocardiography. To our knowledge, this is the first case of leprosy associated with PH with a detailed clinical description. We recommend that physicians be aware of this rare comorbidity in patients with leprosy. Early echocardiographic screening is necessary for symptomatic patients. (Iranian Heart Journal 2024; 25(4): 100-104)