A Case of Lepromatous Leprosy with Laryngeal Involvement Presenting as Dysphonia

ABSTRACT

Involvement of larynx is a uncommon manifestation but could be the first time when the patient may be reporting to a specialist. This is the case report of a 65-year-old man who presented with dysphonia, was evaluated and was diagnosed as lepromatous leprosy with laryngeal involvement. On clinical examination the patient was found to have signs of leprosy – leonine face, nodular involvement of ears, madarosis, oedema of hands and feet, trophic ulcer on right foot. Bilateral greater auricular nerves were found to be enlarged. Video laryngoscopy revealed pale edematous epiglottis, arytenoid and aryepiglottic folds, with nodules on epiglottis. Biopsy from aryepiglottic fold and skin both was done. The diagnosis of lepromatous leprosy was confirmed with histopathology of biopsy from both skin and epiglottic fold. MRI imaging of the neck with contrast showed diffuse hyperintensity in the glottic-supraglottic larynx with asymmetry in the aryepiglottic fold and vocal cord. This experience shows that clinical suspicion is most critical element in reaching the diagnosis of leprosy