A 50-year-old fisherman from a coastal region presents to a dermatology clinic with a gradual worsening of skin lesions over the past three years. He reports widespread, symmetrically distributed nodules and plaques on his face, arms, and legs. He also complains of nasal congestion, frequent nosebleeds, and thickening of his earlobes. Over time, he has developed progressive numbness in his hands and feet, making it difficult to handle fishing nets and tools.

On examination, the patient has multiple erythematous nodules and plaques on his face, including loss of eyebrows (madarosis) and thickened facial skin ("leonine facies"). There is bilateral thickening of the ulnar and common peroneal nerves, with decreased sensation in his extremities. A slit-skin smear reveals numerous acid-fast bacilli, and a skin biopsy confirms lepromatous leprosy with foamy histiocytes and globi of Mycobacterium leprae.

The patient is started on multidrug therapy (MDT) with rifampicin, dapsone, and clofazimine for at least 12 months, with continued monitoring for reactions such as erythema nodosum leprosum. He is also referred for nerve function assessment and rehabilitation to prevent disability. Contact tracing is initiated to screen his close family members for leprosy.