The objective of this study is to present the paleopathological lesions relevant to the discussion of the differential diagnosis of leprosy. Macroscopic, histological and X-ray observation of the bones and scrutiny of lesions according to the paleopathological literature allowed the identification of a probable case of leprosy in an adult male from Angeghakot (Early Middle Age, skeleton 4). The skeleton of a male (50–55 years) revealed several bony changes indicative of leprosy with clear rhino-maxillary syndrome. There is a scarcity of information in the osteoarchaeological literature of leprosy in ancient Armenia. The significance of this case is that it adds to an understanding of the history of the disease in Armenia and to the data set necessary to understand the epidemiological dynamics in the South Caucasus during the Early Middle Ages