TY - JOUR KW - Leprosy KW - Nasal Symptoms KW - Nasal clinical manifestations (NCM) AU - Samra T AU - Herbert S AU - Maderal A AB -

Nasal clinical manifestations (NCM) of leprosy have long been described, particularly in lepromatous disease. However, recent literature consists primarily of case reports and series, making it difficult to appreciate the scale of NCM. We report the prevalence and characteristics of NCM in a single-site US-based cohort of 116 patients with leprosy (May 2011-October 2022). 32 patients (36.4%) had documented NCM at any point during follow-up. Symptoms included: anosmia (2.8%), nasal cartilage pain/hypersensitivity (5.6%), epistaxis (11.1%), septal erosion/perforation (16.7%), saddle nose (16.7%), skin changes (rash/edema) (16.7%), and persistent congestion or rhinitis (30.6%). Of the 32 NCM patients, 25 (78.1%) had one nasal problem, while 7 (21.9%) had multiple. 27 patients (84.4%) had multibacillary disease, versus 5 (15.6%) with paucibacillary. The association between WHO classification and having NCM did not reach statistical significance(p=.052). No relationship between age, gender, or ethnicity and developing NCM was found. Only 25% of NCM patients reported a nasal problem at their initial visit. Overall, ∼40% of our leprosy patients exhibited NCM. In fact, several patients had chronic nasal congestion and epistaxis for years prior to leprosy diagnosis. Earlier recognition of these symptoms as due to leprosy may have helped them avoid the severe downstream consequences that come with delayed treatment of the disease, including permanent disability and need for surgery. Providers in high-risk areas should consider leprosy in patients with refractory NCM. Clinicians who treat leprosy patients should implement regular clinical assessment of nasal structures and utilization of validated nasal function metrics.

BT - Journal of the American Academy of Dermatology LA - ENG M3 - Article N2 -

Nasal clinical manifestations (NCM) of leprosy have long been described, particularly in lepromatous disease. However, recent literature consists primarily of case reports and series, making it difficult to appreciate the scale of NCM. We report the prevalence and characteristics of NCM in a single-site US-based cohort of 116 patients with leprosy (May 2011-October 2022). 32 patients (36.4%) had documented NCM at any point during follow-up. Symptoms included: anosmia (2.8%), nasal cartilage pain/hypersensitivity (5.6%), epistaxis (11.1%), septal erosion/perforation (16.7%), saddle nose (16.7%), skin changes (rash/edema) (16.7%), and persistent congestion or rhinitis (30.6%). Of the 32 NCM patients, 25 (78.1%) had one nasal problem, while 7 (21.9%) had multiple. 27 patients (84.4%) had multibacillary disease, versus 5 (15.6%) with paucibacillary. The association between WHO classification and having NCM did not reach statistical significance(p=.052). No relationship between age, gender, or ethnicity and developing NCM was found. Only 25% of NCM patients reported a nasal problem at their initial visit. Overall, ∼40% of our leprosy patients exhibited NCM. In fact, several patients had chronic nasal congestion and epistaxis for years prior to leprosy diagnosis. Earlier recognition of these symptoms as due to leprosy may have helped them avoid the severe downstream consequences that come with delayed treatment of the disease, including permanent disability and need for surgery. Providers in high-risk areas should consider leprosy in patients with refractory NCM. Clinicians who treat leprosy patients should implement regular clinical assessment of nasal structures and utilization of validated nasal function metrics.

PY - 2024 T2 - Journal of the American Academy of Dermatology TI - 53590 Nasal Symptoms in Leprosy ER -