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.