Leprosy Mimicking as Rheumatoid Arthritis: A Case Report

Abstract

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which mainly damages the skin and peripheral nerves, and can also infect joints and bones. Clinical manifestations are complex, varied, and often underdiagnosed. The clinical manifestations vary and are called "the great imitator". musculoskeletal features are common in leprosy but infrequently reported. A case of borderline lepromatous (BL) type leprosy was initially suspected as rheumatoid arthritis in a 20-year-old Balinese male who complained of pain and swelling in small joints, accompanied by lesions in the form of multiple erythema macules, round-shaped geography, indistinct boundaries, with bilateral distribution is almost symmetrical in the face, thoracoabdominal, and extremity regions. The diagnosis of BL type leprosy is based on history taking, physical examination, and investigations in the form of Ziehl-Neelsen stain and blood tests.

Joint-related manifestations of leprosy: A case report

“…Finally, leprosy was confirmed by the test results, and the patient was prescribed multi-drug therapy as recommended by the WHO. Sridana et al reported a case in which leprosy mimicked rheumatoid arthritis [17]. In this case, a 20-year-old Balinese male initially presented with pain and swelling in small joints, raising suspicion of rheumatoid arthritis [17].…”

“…Sridana et al reported a case in which leprosy mimicked rheumatoid arthritis [17]. In this case, a 20-year-old Balinese male initially presented with pain and swelling in small joints, raising suspicion of rheumatoid arthritis [17]. Additionally, he exhibited lesions resembling multiple erythema macules with round-shaped geography, indistinct boundaries, and nearly symmetrical bilateral distribution on the face, thoracoabdominal, and extremity regions [17].…”

“…In this case, a 20-year-old Balinese male initially presented with pain and swelling in small joints, raising suspicion of rheumatoid arthritis [17]. Additionally, he exhibited lesions resembling multiple erythema macules with round-shaped geography, indistinct boundaries, and nearly symmetrical bilateral distribution on the face, thoracoabdominal, and extremity regions [17]. The diagnosis of borderline lepromatous (BL) type leprosy was confirmed through history taking, physical examination, and investigations, including Ziehl-Neelsen stain and blood tests [17].…”

New insights at the interface between leprosy and immune-mediated rheumatic diseases

“…The spectrum of musculoskeletal manifestations related to leprosy is quite varied ( Table 1 ), including Charcot arthropathy secondary to peripheral sensory neuropathy, swollen hands and feet syndrome, septic arthritis, acute polyarthritis of the leprosy reaction, and chronic arthritis caused by infiltration directly from the synovium by the leprosy bacillus ( 9 ).…”

“…Sacroiliitis is not common, although the presence of sclerosis, erosions, and narrowing of the cartilage space in the sacroiliac joints was present in 35 of 55 radiographs in a study. It did not correlate with lower back pain, and LL was the most common subtype associated with this manifestation ( 9 ).…”