02071nas a2200373   4500000000100000008004100001260005800042653002800100653002400128653002800152653002200180653001100202653001200213653000900225653002500234653002700259653003300286653003100319653001600350100001400366700001500380700001400395700001500409700001400424700001400438700001300452700001400465700001400479245010700493300001000600490000700610520106600617022001401683       2011                            d  c2011 DecbLippincott Williams & WilkinsaPhiladelphia10aAdrenal Cortex Hormones10aAutoimmune Diseases10aDiagnosis, Differential10aDiagnostic Errors10aHumans10aleprosy10aMale10aMycobacterium leprae10aSarcoidosis, Pulmonary10aStill's Disease, Adult-Onset10aTomography, X-Ray Computed10aYoung Adult1 aSimeoni S1 aPuccetti A1 aTinazzi E1 aCodella OM1 aSorleto M1 aPatuzzo G1 aColato C1 aTessari G1 aLunardi C00aLeprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease.  a432-50 v173 a<p>Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. We describe the case of a 20-year-old man from India living in Italy since 2003, who presented with erythematous papules and nodules distributed on his arms, legs, and face in 2006. He also had episodes of high fever, polyarthritis, and episcleritis. Sarcoidosis was suspected on the basis of elevated angiotensin-converting enzyme and bronchoalveolar lavage fluid, and the patient was treated with corticosteroids for about a year. A flare of the disease occurred each time corticosteroid was tapered or suspended. An autoinflammatory disease was then suspected and treated with immunosuppressant. Only the third deep skin biopsy revealed the presence of M. leprae. The lack of clinical suspicion and the unfamiliarity with the histology of leprosy delayed diagnosis and treatment. Leprosy should be considered in the differential diagnoses of patients presenting with rheumatic and cutaneous manifestations especially when they come from countries where the disease is endemic.</p>  a1536-7355