Laryngeal involvement causing dysphonia in a 29 year old nursing mother with lepromatous leprosy

Abstract

Leprosy is a granulomatous disease that mainly affects the skin and peripheral nerves. It is caused by infection with mycobacterium leprae or mycobacterium lepromatosus. In most instances, diagnosis of leprosy can easily be made based on the clinical signs and symptoms. However, when patients present with atypical features, clinical diagnosis can be a challenge. We report a case of a nursing mother with lepromatous leprosy who presented with dysphonia and skin lesions initially thought to be a deep cutaneous mycosis.

Keywords: Leprosy; atypical features; deep cutaneous mycosis; dysphonia.

Figure 1

A) skin colored papules and nodules on dorsum of hands and posterior aspect of both forearms present at initial presentation of the patient; B) reduced number and size of skin lesions about a month after commencing multidrug treatment for multibacillary leprosy

Figure 2

A) granulomas in dermis extending into fatty tissue; B) Normal epidermis, vacuolation and foam cells in dermis, chronic inflammatory cells also present (H&E, x40); C) Foam cells with bacilli (H&E, x400); D) granulomas with langerhan's giant cells (H&E, x400); E) Mirriads of bacilli (Wade-fite stain, x400); F) Lower epidermis, and cells with multiple bacilli in the upper dermis (Wade-fite, x400)