Discussion
Since the first meeting of the World Health Organization’s Leprosy
Expert Committee in 1956, the prevalence of leprosy has decreased
worldwide. However, there are still endemic leprosy areas, such as India
and Indonesia. Regarding the epidemiology of leprosy in Saudi Arabia,
Asiri et al. reported the occurrence of 242 new leprosy cases over a
10-year period spanning 2003-2012. Leprosy is known to exist in Saudi
Arabia, with a geographical distribution showing clustering of cases in
the South-Western and Eastern regions of the country. Unlike our case,
as she presented in Riyadh, at the central region of the country.
However, she was born and lived fifteen years of her life in Al-Khurma,
which is a city in the western region of the country. Emphasizing the
importance of taking a thorough past medical and social history.
Of diagnosed leprosy patients in Saudi Arabia, 57% are immigrants, and
leprosy is more common in males than females at a ratio of 3:1. Our
patient is of a Saudi nationality, with no direct physical contact with
immigrants nor recent contact with patients known to have leprosy. She
had no history of travelling abroad.
Dermatological
lesions and peripheral neuropathy are the cardinal clinical features of
leprosy. Unlike our case, Swain SK. and his colleagues report that the
clinical presentation in their case was chronic unilateral nasal
obstruction and unilateral/ same side intermittent epistaxis. Other case
presented with chronic nasal congestion, rhinorrhea, intermittent
epistaxis, and headache. Our patient was complaining of on/off bilateral
nasal obstruction for five months associated with nasal discharge,
facial rash, and erythema around nasal bridge started four months prior
to her first presentation. No epistaxis.
Upon physical examination, the case report done by Swain SK presented
with a small reddish mass in the anterior part of nasal cavity. Al-Aboud
et al. reported a case with asymptomatic reddish plaque over the nose
extending to malar area measuring 12 cm in diameter for six months.
Nasal tip drop, or saddle nose, has been reported in the literature due
to cartilaginous destruction with no nasal tip necrosis. Our patient,
however, presented with midfacial edema with no septal perforation. Then
nasal tip necrosis in a later presentation. This unusual presentation
led to a delay in the final diagnosis which was based on
histopathological examination.