The enigmatic rhinitis: A nasal clue to Hansen’s disease

Leprosy can present with subtle or atypical symptoms, particularly involving the upper respiratory tract, which may lead to misdiagnosis. Allergic rhinitis is a common condition, and overlapping nasal symptoms may distract clinicians from considering Hansen’s disease. We report a 37-year-old male who was repeatedly treated for allergic rhinitis due to chronic nasal obstruction, episodic sneezing, and persistent watery rhinorrhea. Despite treatment with antihistamines, intranasal corticosteroids, and saline irrigation for five months, his symptoms did not improve. Further evaluation revealed a xerotic patch, ear lobe infiltration, and thickened peripheral nerves. Slit-skin smear from the ear lobe demonstrated abundant acid-fast bacilli, confirming the diagnosis of lepromatous leprosy. Multidrug therapy was initiated, resulting in marked symptomatic improvement. This case highlights that leprosy should be considered in patients with chronic or atypical rhinitis unresponsive to standard therapy, and that thorough cutaneous and neurological examination remains critical for early diagnosis.