Mediastinal lymphadenopathies and skin lesions in a 49-year-old Sinhalese man

Leprosy is a neglected disease sporadically reported in high-income countries. Skin lesions and peripheral nerve involvement represent the most common manifestations. Mediastinal lymphadenopathy in the absence of superficial lymph node involvement is very rare. Atypical or rare clinical presentations of the disease may delay diagnosis and therapy and cause potential life-threatening manifestations and disabilities. We describe the case of a 49-year-old Sinhalese man who was admitted to our hospital with a one-month history of peripheral neurological symptoms and skin lesions on lower limbs. A computed tomography scan showed the presence of mediastinal lymphadenopathies without lung parenchymal and superficial lymph node involvement. Endobronchial ultrasound-guided transbronchial needle aspiration showed the presence of granulomas, while skin biopsy revealed dermo-hypodermic granulomas with perineural lymphohistiocytic inflammatory reaction. Fite-Faraco staining demonstrated the presence of acid-fast bacilli in both lymph nodal and skin biopsy, and the polymerase chain reaction was positive for Mycobacterium leprae. Multibacillary leprosy was then diagnosed.