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Leprosy presenting with vascular involvement is very rare or is probably under-reported. Arteriographic and histopathological analysis has shown vascular involvement in few individuals with leprosy previously. It has also been found that vascular abnormality is central to the pathogenesis of trophic ulcer and nerve damage itself. A 37-year-old male presented to our center with pain, bluish discoloration and recurrent ulceration of digits of hands and feet of twelve months duration. Investigations revealed diminished caliber of the brachial artery with no other underlying abnormality. Dermatological review revealed features of primary neuritic leprosy confirmed by nerve biopsy and polymerase chain reaction (PCR) for Mycobacterium leprae positivity. This case highlights the fact that vascular involvement could rarely be a primary event in leprosy and cause Buerger's disease-like manifestations.