Leprosy Masquerading as Systemic Rheumatic Diseases

El-Gendy, Hala; Elgohary, Rasmia; Shohdy, Kyrillus S.; Ragab, Gaafar

doi:10.1097/rhu.0000000000000379

Cited by 19 publications

(15 citation statements)

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“…The typical joints affected are the wrists, small joints of the hands and feet, as well as the knees. [ 5 ] The insidious onset of chronic symmetrical poly-arthritis may be easily misdiagnosed as RA, independent or arthritis-related neuropathy or tenosynovitis. The prevalence of Hansen disease-related arthritis is described in up to 75% of these patients, which can be accompanied by or precede skin lesions and may be the only manifestation, [ 5 – 7 ] and it is the third commonest after dermatological and neurological manifestations.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] The insidious onset of chronic symmetrical poly-arthritis may be easily misdiagnosed as RA, independent or arthritis-related neuropathy or tenosynovitis. The prevalence of Hansen disease-related arthritis is described in up to 75% of these patients, which can be accompanied by or precede skin lesions and may be the only manifestation, [ 5 – 7 ] and it is the third commonest after dermatological and neurological manifestations. [ 8 ] The bone joint damage caused by Hansen disease is divided into three categories: direct bone damage, mainly in leprosy osteitis and expansive bone destruction; secondary bone joint damage due to neurovascular disease, mainly in bone resorption and Charcot's joint; osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

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Rheumatoid arthritis-like features in Hansen disease

2018

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Rationale:Hansen disease is an infectious chronic disease with various clinical manifestations. Its joint performance may easily mimic rheumatoid arthritis.Patient concerns:We report a case of a 57-year-old woman diagnosed with Hansen disease 10 years ago, who suffered from joints swelling, pain and joints deformities of both hands for 19 years. The skin on the hands showed rashes, thickening, desquamation and chapping, with both thenar muscles atrophy. She also had severe hypoalgesia of the whole body, and morning stiffness for one hour.Diagnoses:The final diagnosis was joint damage and peripheral neuropathy due to Hansen disease.Interventions:The patient received neurotrophic treatment instead of anti-rheumatic treatment.Outcomes:At 1-year follow up, no further aggravation of joint swelling and pain was detected.Lessons:The correct diagnosis of Hansen disease involving joints depends on the combination of medical history, careful physical examination, and laboratory examination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rheumatoid arthritis-like features in Hansen disease

2018

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“…Considering cutaneous manifestations, these range from flat, sharply defined macules in tuberculoid lesions to diffuse infiltration and indurated plaques and nodules in lepromatous lesions [1]. Despite often belittled, rheumatic complaints can arise, and vary from feeble arthralgia/ to pictures fully mimicking systemic rheumatic diseases [8]. Prevalence is inconstant between studies, ranging between 1 and 78% [2, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report

et al. 2019

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Background Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. Case report A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. Conclusion This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.

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“…The most frequently demonstrated autoantibodies in leprosy are rheumatoid factor, anti-nuclear antibody, anti-Sjogren syndrome B antibody, ANCAs, and anti-phospholipid antibodies. [ 4 ] There are some plausible theories explaining the presence of serological autoantibodies in leprosy. M. leprae infects hosts through mucosa of upper respiratory tract and then binds to G domain in Schwann cells.…”

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confidence: 99%