Leprosy is a neglected chronic infectious disease transmitted by nasal secretions or saliva containing the bacilli of Mycobacterium leprae. Lepromatous leprosy (LL) can affect bones, skin, and peripheral nerves. The most common site involved in the upper aerodigestive tract is the nasal cavity, but the pharynx, larynx, and oral cavity can also be affected. This paper aims to report a case of a patient with LL (multibacillary) diagnosed with oral involvement in IPEC / Fiocruz. A man, 63 years of age, a truck driver, hypertensive, and a smoker and drinker visited the outpatient clinic of the IPEC / Fiocruz for the removal of myiasis, reporting nasal secretions, nasal obstruction, and a sore throat, with about 7 years of evolution without a diagnosis. Crusting was observed in the nasal vestibule, and septal perforation and injury leucoeritroplásica infiltrated the hard palate and uvula. He also had irregular, white spots on the scalp, alopecia, injuries to the earlobes, and discreet elbows and leonine facies. Mycobacterium leprae bacilli were evidenced in the histopathology and in an examination of lymph from the ears. The patient was treated with dapsone, rifampicin, and clofazimine for progressive lesions, and is currently being followed and monitored. A multidisciplinary diagnosis and early treatment is essential in leprosy patients to decrease the risk of contagion. Despite being a disease of low morbidity, with proper diagnosis and treatment, sequelae such as adhesions, septal perforation, and palatal fibrosis, which in severe cases may progress to paralysis of muscles, impairing speech and swallowing, can be prevented.