Leonine Facies: The Face of a Forgotten Disease

A 45-year-old woman presented with a five-year history of paresthesia of both hands and feet, along with modification of facial features. On physical examination, she had coarse ‘leonine like’ facies, with thickened skin of face and eyelids, her face had multiple nodular lesions that coalesced into plaques, especially on the forehead. She had madarosis and a saddle-nose (Figures 1 and 2). We also observed strabismus, ulcers on hands and feet with a swan neck deformity of fingers (Figures 3 and 4). After the strongly suggestive hypothesis of lepromatous leprosy, we performed a skin biopsy which confirmed the disease. The patient underwent standard anti-bacillary multidrug therapy for 12 months, with good improvement.