BACKGROUND: Leprosy is a chronic infectious disease caused by the Mycobacterium leprae affecting most commonly skin and peripheral nerves. Patients with Lepromatous Leprosy remain asymptomatic for years, and harbor bacteria in the nasal cavity, and these patients are responsible for the transmission of the disease in the community. In the advanced stage (stages 4 and 5) the involvement of nasal septum results in saddle nose deformity in most patients. METHODS: In this post-leprosy elimination era, this is a rare presentation with saddle nose deformity mimicking atrophic rhinitis. It was diagnosed based on the microbiological examination (AFB staining) of the nasal discharge. RESULTS: ZN Stain shows acid-fast bacilli in globi suggestive of Mycobacterium Leprae. On slit examination of the skin smear of the Right ear lobule also showed positive for acid-fast bacilli with bacteriological index 6+. CONCLUSION: In this post-elimination era, leprosy should also be considered a differential diagnosis for atrophic rhinitis that is not responding to routine treatment. With early diagnosis and timely initiation of appropriate treatment, such damage can be minimized.