Subcutaneous Nodules and Joint Deformity in Leprosy

Abstract

Leprosy (Hansen's disease), known to be caused by Mycobacterium leprae, is a well-known illness with multiple rheumatologic manifestations. This chronic granulomatous infection has clinical features that are variable, depending on the immune response of the host. Manifestations consist mainly of involvement of the peripheral nerves, skin, upper respiratory system, eyes, and testes, as well as joints. Musculoskeletal manifestations include arthralgias, arthritis, Charcot arthropathy, and positive autoantibodies. We report a case of a Puerto Rican-born woman who was living within the northeastern United States and had subcutaneous nodules, saddle nose deformity, and painless contractures of her fingers and toes. This case illustrates some of the musculoskeletal manifestations of leprosy to raise awareness of this disease as part of the differential diagnosis of articular abnormalities with subcutaneous nodules in a nonendemic country.

Evaluation of rheumatoid factor and anti‐citrullinated peptide antibodies in relation to rheumatological manifestations in patients with leprosy from Southern Brazil

“…Finally, arthralgia due to ENL, neuropathy or arthritis is a very frequent complaint in leprosy patients and can be associated with physical incapacity . As expected, ENL and neuropathy were observed in a considerable number of the patients, especially those with the MB forms, confirming previous findings .…”

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

“…This often delays the diagnosis. Patients with chronic Hansen's disease can develop inflammatory arthritis, often polyarthritis, with early morning stiffness that can mimic RA, 7–9 seronegative spondyloarthritis 10 . and other inflammatory rheumatic disorders 6 .…”

An Unusual Presentation of Lepromatous Leprosy

“…However, initial clinical manifestation in muscle, lymph node, larynx, liver, spleen, bone marrow, bone and testes (proven by biopsy) has been infrequently reported [2].In pure neuritic leprosy patient may not show any skin lesion [3]. Occasionally musculoskeletal involvement precedes characteristic cutaneous and / or neural involvement [4]. The involvement of skeletal muscle in leprosy is considered secondary to peripheral nerve involvement, but some studies point to a primary muscle lesion [5].…”