Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae^1,2. Despite significant reductions in disease burden worldwide, India continues to account for a substantial proportion of newly diagnosed cases³. The disease primarily affects the skin and peripheral nerves; however, systemic involvement may occur in advanced multibacillary disease.

Laryngeal involvement is an uncommon manifestation, predominantly encountered in patients with long-standing lepromatous leprosy⁴. The disease process generally begins in the supraglottic region and may progressively involve the epiglottis, aryepiglottic folds, false vocal cords, and true vocal cords^5,6. Clinical manifestations range from mild hoarseness to life-threatening airway obstruction⁷.

Due to its rarity and nonspecific presentation, laryngeal leprosy is frequently underdiagnosed⁸. This study presents a retrospective series of ten patients with histologically confirmed laryngeal leprosy and highlights the characteristic clinical and endoscopic features relevant to otolaryngologists.

MATERIALS AND METHODS

Study Design- Retrospective observational case series.

Study Setting- Department of Otorhinolaryngology at a tertiary care teaching hospital.

Study Period- January 2018 to December 2025.

Inclusion Criteria

1. Histopathologically confirmed lepromatous leprosy.
2. Evidence of laryngeal involvement on laryngoscopy and/or imaging.
3. Availability of complete clinical records.

Exclusion Criteria

1. Incomplete records.
2. Alternative causes of laryngeal pathology such as malignancy, tuberculosis, fungal infection, or trauma.

Data Collection

The following variables were reviewed:

Demographic characteristics, Clinical presentation, Cutaneous manifestations, Laryngoscopic findings, CT neck findings, Histopathological features, Treatment administered, Clinical outcomes

RESULTS

Demographic Characteristics- A total of ten patients were identified. All patients were male with a mean age of 47.9 years.

Clinical Presentation- Symptom Number (%) Hoarseness- 10 (100%) Dyspnea- 6 (60%) Dysphagia-4 (40%) Dysphonia -10 (100%) Stridor -2 (20%) Cutaneous Findings All patients exhibited features suggestive of advanced lepromatous disease: Leonine facies (figure 1), Madarosis, Saddle nose deformity, Ear nodules, ulceration, toe deformity (figure 2) and Distal sensory impairment.

Endoscopic Findings (figure 3)- Epiglottic edema- 10 (100%) Aryepiglottic fold thickening -10 (100%), False vocal cord edema-10 (100%) Vocal cord palsy-6 (60%), Glottic narrowing-10 (100%).

Chart 1: Clinical Presentation of cases.

Radiological Findings, Contrast-enhanced CT neck demonstrated:

Thickened epiglottis, thickened aryepiglottic folds, Supraglottic narrowing, Variable glottic compromise, three patients demonstrated severe airway narrowing (figure 4).

Histopathological Findings, Biopsy specimens revealed:

Dense subepithelial inflammatory infiltrates, Foamy macrophages, Granulomatous inflammation (figure 5). Numerous acid-fast bacilli on Fite-Faraco staining.

Histological confirmation was obtained in all patients.

Figure 1: Leonoid facies                                            Figure 2: Deformities affected feet

Figure 3: Video Laryngoscopic picture                        Figure 4: NCCT neck

Figure 5: Histo-Pathological image

DISCUSSION

Laryngeal involvement in leprosy was more common in the pre-multidrug therapy era, with reported incidence ranging from 6% to 75% in advanced lepromatous disease³. The supraglottic region is particularly vulnerable because of its lower temperature, which favors proliferation of M. leprae. In the present series, hoarseness was the universal presenting complaint. Similar findings have been reported in previous studies where dysphonia represents the earliest symptom of laryngeal infiltration. Progressive edema and fibrosis may eventually result in airway compromise.

Video Laryngoscopy consistently demonstrated involvement of the epiglottis and aryepiglottic folds. Vocal cord palsy was observed in 60% of patients, highlighting the potential severity of laryngeal disease.

Once the patients got diagnosed, their airway was secured with tracheostomy tubes.  Later they started with lepromatous multi-drug treatment as per protocol and asked for follow-up.

The differential diagnosis includes:

Laryngeal tuberculosis Sarcoidosis Granulomatosis with polyangiitis Amyloidosis Laryngeal malignancy Histopathological confirmation remains the diagnostic gold standard.

Early diagnosis is essential because prompt multidrug therapy can halt disease progression and reduce the risk of airway obstruction.

CONCLUSION

Laryngeal leprosy is a rare but important manifestation of advanced lepromatous disease. Hoarseness in patients with cutaneous signs of leprosy should raise suspicion for laryngeal involvement. Flexible laryngoscopy, CT imaging, and histopathological confirmation are crucial for diagnosis. Early recognition and treatment can prevent significant morbidity and airway compromise.

DECLARATIONS

Funding -None.

Conflict of Interest

The authors declare no conflict of interest.

Ethical Approval

Institutional Ethics Committee approval was obtained for retrospective review of patient records.

Informed Consent

Waived due to retrospective study design.

Author Contributions

All authors contributed to study conception, data collection, analysis, manuscript preparation, and final approval.

REFERENCES

1. Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL. Leprosy. Clin Microbiol Rev. 2006;19(2):338–381.
2. Jopling WH, McDougall AC. Handbook of Leprosy. 5th ed. New Delhi: CBS Publishers; 1996.
3. World Health Organization. Global leprosy update 2024. Geneva: World Health Organization; 2025. Available from WHO Global Leprosy Programme. India remains among the countries contributing the largest number of new leprosy cases worldwide.
4. Jaffe L. Leprosy of the nose, throat and ears: a neglected subject. Int J Lepr Other Mycobact Dis. 1971; 39:444–449. (Classic paper describing ENT manifestations including laryngeal involvement.)
5. Gupta OP, Jain RK, Tripathi PP, Gupta S. Leprosy of the larynx: a clinicopathological study. Int J Lepr Other Mycobact Dis. 1983; 51:171–175. (Describes characteristic laryngeal lesions in lepromatous leprosy.)
6. Malik R, Ahuja P, Chandra K. Leprosy of the larynx. Int J Lepr Other Mycobact Dis. 1975;43(2):114–115. (Reports epiglottic and vocal cord involvement in lepromatous disease.)
7. Fleury RN, Duerksen F. Emergency in leprosy: involvement of the larynx. Lepr Rev. 2007; 78:148–150. (Highlights airway compromise and obstructive manifestations.)
8. de Guia CE, Venida-Tablizo A. Lepromatous leprosy with laryngeal involvement. Indian J Dermatol Venereol Leprol. 2021;88(1):106–109. (Recent report emphasizing clinical and radiologic findings of laryngeal leprosy.)