Background: A notification received from state of Chhattisgarh in July, 2018 that 10 cases in a family of 14 members at Salaunikhurd village, Bhatgaon Primary Health Center (PHC), Block Bhilaigarh of Balodabazar district diagnosed as leprosy cases. In response, an investigation team was constituted by Central Leprosy Division to carry out the epidemiological investigation. Aim: To find out reasons of high leprosy endemicity, detailed investigation of multicase family and assessment of health service delivery in village. Methods: House to house survey of the village was carried out to find out new cases along with clinicepidemiological assessment of all patients affected with leprosy. Detailed investigation of two MCFs and assessment of health service delivery from block to the village level was carried out. Results: 84% of the village population screened for leprosy, two new leprosy cases, three defaulter and two newly developed Grade 2 Deformity (G2D) cases were identified during survey. All the cases in the Multi-case Family (MCF) were MB leprosy cases. Atypical signs and symptoms of leprosy - infiltrations and nodules over skin, low socio-economic status, poor housing condition, high family density, poor sanitation, seasonal migration, poor health seeking behaviour, lack of awareness on the disease and health system ignorance are the major factors led to delay in detection. Conclusion: Analysis of case detection trend in the region across the years indicates a smouldering epidemic of Leprosy. Multiple factors are responsible for the occurrence of multiple cases of leprosy within a family. Limitations: 100% population could not survey due to time constraint, harvesting season and migration. Molecular epidemiology study needed to explore the genetic structure which contributed MCF.