Cauliflower Ear in Lepromatous Leprosy

A 49-year-old man presented with asymptomatic, raised lesions over his left ear for three years. On physical examination, he had diffuse infiltration and thickening with multiple well-defined, skin-colored, firm, nontender papules and nodules of size ranging from 0.3 cm to 1.3 cm over the helix, antihelix, lobule, and tragus of left ear, simulating a cauliflower appearance. There was no regional lymphadenopathy. He also had generalized xerosis with multiple, ill-defined, hypochromic macules over his trunk, arms, and thighs. Peripheral nerve examination showed thickening of left ulnar nerve with hypoanesthesia along its distribution. No motor deficits were found in the clinical evaluation. Mycobacterium leprae has the predilection to involve cooler body sites such as pinna and lobule. Infiltration, nodule formation, ulceration with a "nibbled" or "rat-bitten" defect, megalobule, and auricular chondritis are the reported external ear manifestations of leprosy.