Lest we forget Hansen's disease (leprosy): an unusual presentation with an acute onset of inflammatory polyarthritis and the rheumatology experience

Abstract

Several forms of arthritis and rheumatism can sometimes complicate leprosy. However, its presentation as an acute onset arthritis is unusual. We report two adult male naïve patients who presented to our rheumatology outpatient clinic with acute onset inflammatory polyarthritis, skin rash and mild sensory neurodeficit. Borderline lepromatous leprosy (in type I lepra reaction) was diagnosed. We also refer to 19 case records of Hansen arthritis in the clinic database (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)) from approximately 35,000 patients and a community study to highlight the missed diagnosis of Hansen's disease and its unusual association with rheumatoid arthritis. In countries like India where leprosy is endemic, this disease also merits attention in rheumatology clinics.

Hansen’s Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States

“…Arthritis is the third most common symptom of HD, and as this series shows, patients often suffer long delays and misdiagnosis with other rheumatologic diseases when they have chronic arthritis with HD. Multiple case reports and series of chronic arthritis and HD have been published previously predominantly from the high-burden countries of India and Brazil, 17,[19][20][21][22][23][24][25][26] although a few case reports are from the US 16 or other western countries 27 among patients who have immigrated from other areas known to be endemic for HD. To our knowledge, this is the first series of cases of HD patients with chronic arthritis described in the US.…”

Leprosy in a rheumatology setting: a challenging mimic to expose

“…Finally, just like syphilis, Hansen’s disease is a great mimic and needs an astute clinical sense with a high index of clinical suspicion to capture it early enough for an effective and complete cure [13]. The disease manifestation depends on the status of the host T cell immunity.…”

“…More uncommonly, this presentation may be an acute inflammatory polyarthritis mimicking RA: two males with borderline lepromatous leprosy presented with type I reaction in our rheumatology outpatient [13]. We did not find tenosynovitis in isolation though leprosy has been uncommonly diagnosed in a patient with tenosynovitis (in the absence of arthritis) with thickened nerves [14].…”

Recurrent ulcers: A diagnostic challenge

“…This case report highlights the importance of a thorough clinical examination in such a situation and re-emphasizes the importance of looking for signs and symptoms of leprosy in this well-known but relatively uncommon entity. [5]…”