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.
BT - Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases C1 - http://www.ncbi.nlm.nih.gov/pubmed/22089994?dopt=Abstract C2 - USA CY - Philadelphia DA - 2011 Dec DO - 10.1097/RHU.0b013e31823a55e5 IS - 8 J2 - J Clin Rheumatol LA - eng M3 - Case report N2 -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.
PB - Lippincott Williams & Wilkins PP - Philadelphia PY - 2011 SP - 432 EP - 5 T2 - Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases TI - Leprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease. VL - 17 SN - 1536-7355 ER -