Saddle-Nose Deformity in the Setting of Diffuse Cutaneous Lesions in an African American Man | Dermatology | JN Learning | AMA Ed Hub [Skip to Content]
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Saddle-Nose Deformity in the Setting of Diffuse Cutaneous Lesions in an African American Man

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 66-year-old African American man presented to the otolaryngology clinic with a several-month history of severe nasal congestion. Five years before this otolaryngology evaluation, the patient developed diffuse skin plaques with erythema and was subsequently diagnosed with hypopigmented cutaneous T-cell lymphoma (CTCL, mycosis fungoides type). The patient was treated with a regimen of narrowband UV-B phototherapy and triamcinolone cream, which he has continued for 4 years. Owing to significant worsening of his symptoms 4 months before his evaluation, a biopsy of his cutaneous lesions was performed to rule out progression of CTCL (Figure 1). Physical examination demonstrated large annular plaques with peripheral hyperpigmentation of the body. There were also confluent, indurated pink plaques with slightly raised edges along the forehead, malar eminence, and scalp. The nasal septum demonstrated an inverted V deformity with compromise of the keystone junction. Nasal passages were obstructed with thick mucus and synechiae formation, nearly obstructing the entire nasal passage bilaterally.

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C. Lepromatous leprosy

Leprosy, also known as Hansen disease, constitutes a bacterial infection by either Mycobacterium leprae or M lepromatosis. The bacterium is an acid-fast bacillus that is typically slow growing, with a predilection for growth within macrophages, endothelial cells, and Schwann cells. Humans are primary carriers of the bacterium; however, 9-banded armadillos are a well-known reservoir of M leprae within North and South America. Individuals at risk of contracting the disease include those with close contact with an infected individual, exposure to armadillos, and immunosuppression or immunodeficiencies. The HLA-DQ1 gene has been implicated in persons more likely to develop the lepromatous form.1

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Article Information

Corresponding Author: Timothy B. Shaver, MD, Division of Otolaryngology–Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, 2300 M St NW, 4th Floor, Washington, DC 20037 (timshaver@mfa.gwu.edu).

Published Online: July 21, 2022. doi:10.1001/jamaoto.2022.1848

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Eichelmann  K , González  SE , Salas-Alanis  JC , Ocampo-Candiani  J .  Leprosy. an update: definition, pathogenesis, classification, diagnosis, and treatment.   Actas Dermosifiliogr. 2013;104(7):554-563. doi:10.1016/j.ad.2012.03.003PubMedGoogle ScholarCrossref
2.
Fischer  M .  Leprosy—an overview of clinical features, diagnosis, and treatment.   J Dtsch Dermatol Ges. 2017;15(8):801-827. doi:10.1111/ddg.13301PubMedGoogle ScholarCrossref
3.
Maymone  MBC , Laughter  M , Venkatesh  S ,  et al.  Leprosy: clinical aspects and diagnostic techniques.   J Am Acad Dermatol. 2020;83(1):1-14. doi:10.1016/j.jaad.2019.12.080PubMedGoogle ScholarCrossref
4.
Davey  TF , Rees  RJ .  The nasal discharge in leprosy: clinical and bacteriological aspects.   Lepr Rev. 1974;45(2):121-134.PubMedGoogle Scholar
5.
Degang  Y , Nakamura  K , Akama  T ,  et al.  Leprosy as a model of immunity.   Future Microbiol. 2014;9(1):43-54. doi:10.2217/fmb.13.140PubMedGoogle ScholarCrossref
6.
Gupta  A , Seiden  AM .  Nasal leprosy: case study.   Otolaryngol Head Neck Surg. 2003;129(5):608-610. doi:10.1016/S0194-5998(03)00725-3PubMedGoogle ScholarCrossref
7.
Barton  RP .  Clinical manifestation of leprous rhinitis.   Ann Otol Rhinol Laryngol. 1976;85(1 Pt 1):74-82. doi:10.1177/000348947608500113PubMedGoogle ScholarCrossref
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