Chronic rhinosinusitis in ex-lepromatous leprosy patients with atrophic rhinitis.

AIM: Rhino-sinus mucosal involvement is well documented in untreated lepromatous leprosy, but less understood in ex-leprosy patients (i.e. leprosy patients who have been treated and cured) with atrophic rhinitis. MATERIALS AND METHODS: Rhino-sinus abnormalities were investigated in 13 ex-lepromatous leprosy patients with atrophic rhinitis, using interviews enquiring about sinonasal symptoms, nasal endoscopy, nasal swab culture and computed tomography. Endoscopic sinus surgery had been performed in three patients. The clinical course, computed tomography findings and nasal biopsy results of these three patients were evaluated. RESULTS: All patients had turbinate atrophy and 6 of the 13 (46.2 per cent) had septal perforation. Paranasal sinus involvement was noted in 9 of 12 examined patients (75 per cent). The most commonly affected sinus was the maxillary sinus (in 8 of 12; 66.7 per cent). All three patients treated by endoscopic sinus surgery experienced relapse and required further surgery. Maxillary sinus irrigation was effective for reduction of persistent symptoms such as postnasal discharge and crusts. CONCLUSION: Ex-lepromatous leprosy patients with atrophic rhinitis had various rhino-sinus abnormalities and persistent symptoms. These patients had chronic rhinosinusitis because of underlying atrophic rhinitis. These patients required repeated otolaryngological observations together with combined surgery and conservative treatment.

A case of advanced lepromatous leprosy with rhino-oro-laryngological involvement in the post-elimination era.

A patient presenting with symptoms and signs of congestive heart failure was incidentally found to be in advanced stage of leprosy. He had multiple lepromatous nodules over the entire body. The oral mucosa was yellowish with a matte appearance and the palate had a site ready to perforate. Nasal cavity revealed a small septal perforation with overlying crusts suggesting advanced rhinitis. Diagnosis of lepromatous leprosy was confirmed on histology. This case report emphasizes the existence of pockets of highly bacilliferous cases that continue to be a source of infection within the community and highlights the need for enhanced health education.