Development of Leprosy in a Patient with Rheumatoid Arthritis During Treatment with Etanercept: A Case Report

Lluch, Pablo; Urruticoechea, Ana; LLuch, Judit; Moll, María C.; Matos, M. G.; Benet, Josep; Ene, Liliana; Cañete, Juan D.

doi:10.1016/j.semarthrit.2012.03.003

Cited by 20 publications

(9 citation statements)

References 12 publications

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“…[6][7][8][9] There have also been rare cases of patients undergoing therapy for RA with various disease modifying antirheumatic drugs such as tumor necrosis factor alpha inhibitors which then unmasked or exacerbated previously unrecognized HD. [9][10][11][12][13][14][15] A similar effect is seen with Mycobacterium tuberculosis, a much more common and better-known infection related to M. leprae. 12 The interaction and overlap in symptoms of RA and HD is important for medical practitioners to recognize in various specialties of practice.…”

Section: Introductionmentioning

confidence: 74%

“…[9][10][11][12][13][14][15] A similar effect is seen with Mycobacterium tuberculosis, a much more common and better-known infection related to M. leprae. 12 The interaction and overlap in symptoms of RA and HD is important for medical practitioners to recognize in various specialties of practice. Because a combination of treatment of the inflammatory arthritis and the underlying infection are necessary to resolve the symptoms, HD is an important, if infrequent, item on the differential diagnostic list of patients with rash and joint pain.…”

Section: Introductionmentioning

confidence: 74%

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

Labuda

Schieffelin

Shaffer

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Hansen's Disease (HD) is a rare, chronic granulomatous infection of the skin and peripheral nerves caused by the noncultivable organism . Arthritis is the third most common symptom of HD. Subjects with both confirmed HD on skin biopsy and chronic arthritis were identified at the National Hansen's Disease Program (NHDP). We conducted a series of medical chart reviews and extracted and logged personally deidentified data into a database and carried out descriptive analyses. Eighteen of 261 subjects presented to the NDHP with both HD and chronic arthritis between 2001 and 2015. Among these, 16 were male, 16 were white, and 15 were residents of Louisiana. The median age at diagnosis of HD was 67 years. Ten of these subjects were diagnosed with borderline lepromatous leprosy, seven were diagnosed with lepromatous, and one was diagnosed with borderline tuberculoid leprosy. Patients were symptomatic with arthritis for a median of 5.3 years before HD diagnosis. Sixty-two percent of patients (11) were diagnosed with rheumatoid arthritis (RA) before HD diagnosis, and 10 of which were seronegative RA. Hands, feet, wrists, and elbows were most commonly reported as affected joints. Over half of the patients (61%) had completed HD multidrug therapy at the time of review, and 73% of these subjects had persistent joint pain requiring steroids or methotrexate for symptomatic control. Chronic arthritis in HD patients is present in a series of US-acquired cases of HD. Arthritis did not resolve with successful treatment of HD in most cases.

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Section: Introductionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 74%

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

Labuda

Schieffelin

Shaffer

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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“…Inflammatory arthritis was the indication for biologics in nine of the 10 patients, and at least nine of the 10 patients received prior immunosuppressive or immunomodulating medications, including methotrexate, hydroxychloroquine, corticosteroids, and/or leflunomide. 11,12,[14][15][16][17][18][19] (Table 1). In four of the 10 patients, cutaneous findings, including psoriasiform plaques, 17 exfoliative erythroderma, 20 nodules (clinically diagnosed as rheumatoid nodules), 18 and an abdominal rash, were noted before initiation of biologics.…”

Section: Resultsmentioning

confidence: 99%

“…11,12,[14][15][16][17][18][19] (Table 1). In four of the 10 patients, cutaneous findings, including psoriasiform plaques, 17 exfoliative erythroderma, 20 nodules (clinically diagnosed as rheumatoid nodules), 18 and an abdominal rash, were noted before initiation of biologics. 14 The diagnosis of leprosy was confirmed by skin biopsies of new cutaneous eruptions.…”

Section: Resultsmentioning

confidence: 99%

Biologics in Leprosy: A Systematic Review and Case Report

Cogen

Lebas

Barros

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Tumor necrosis factor (TNF)-α inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-α inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-α inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNFα inhibitors. Finally, TNF-α inhibitors appear effective in some cases of refractory ENL.

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“…Rheumatoid arthritis is an autoimmune disorder that results in chronic systemic inflammation. Treatment with antitumor necrosis factor therapies has improved outcomes in patients with rheumatoid arthritis but may result in increased susceptibility to granulomatous pathogens, including M tuberculosis, H capsulatum, and Listeria monocytogenes (37). Rheumatoid arthritis and SLE have also been associated with interstitial granulomatous dermatitis (38), an inflammatory lesion of the skin.…”

Section: Idiopathic Gdmentioning

confidence: 99%

Granulomatous Disease in the Head and Neck: Developing a Differential Diagnosis

Nwawka¹,

Nadgir²,

Fujita³

et al. 2014

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Granulomatous diseases have a varied etiology that includes autoimmune, infectious, idiopathic, and hereditary causes. The unifying factor in these diseases is the formation of granulomas, which histologically are mononuclear inflammatory cells or macrophages surrounded by lymphocytes. Granulomatous diseases often have systemic manifestations that affect organs throughout the body. Granulomatous diseases with head and neck manifestations include granulomatosis with polyangiitis, Churg-Strauss syndrome, Behçet disease, chronic granulomatous disease, and sarcoidosis. Infectious causes include tuberculosis, cat-scratch disease, syphilis, leprosy, actinomycosis, rhinoscleroma, and fungal infections. In the head and neck, granulomatous disease may affect the orbits, sinonasal cavities, salivary glands, aerodigestive tract, temporal bone, or skull base. Imaging findings include sinonasal opacification, ocular and other soft-tissue masses, osseous erosion, airway narrowing, lymphadenopathy, and salivary gland infiltration. Vascular involvement may also be evident, with displacement, narrowing, or occlusion of arteries and veins. Some radiologic findings of granulomatous processes have a considerable overlap with findings of malignancy, and a radiologic differential diagnosis inclusive of both is critical to avoid incorrect clinical treatment. Without the benefit of a prior clinical diagnosis, laboratory findings, or suggestive clinical signs and symptoms, granulomatous diseases may be difficult to differentiate radiologically. Although individual granulomatous diseases may have overlapping findings at imaging, certain radiologic findings should prompt the inclusion of granulomatous diseases in the differential diagnosis, thus facilitating appropriate clinical management.

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Development of Leprosy in a Patient with Rheumatoid Arthritis During Treatment with Etanercept: A Case Report

Cited by 20 publications

References 12 publications

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

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

Biologics in Leprosy: A Systematic Review and Case Report

Granulomatous Disease in the Head and Neck: Developing a Differential Diagnosis

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