Leprosy Mimicking Common Rheumatologic Entities: A Trial for the Clinician in the Era of Biologics

Abstract

Rheumatoid arthritis and seronegative spondyloarthritis, which make up the lion's share of cases attending a rheumatology clinic, are relatively easy to diagnose. However, when an entity of infective aetiology like leprosy known to be a great mimic of different autoimmune conditions presents with features similar to these, the possibility of it being diagnosed at the outset is very slim indeed. The ease with which the diagnosis of leprosy can be missed assumes sinister proportions as the use of disease modifying agents can have deleterious effects in these patients. In the era of increasing availability and use of biologic disease modifying agents, it is imperative not only to actively rule out the presence of leprosy but also to make it a part of the prebiologic screening of patients in whom biologics are being planned to be administered, especially in leprosy endemic areas.

What is new in the pathogenesis and management of erythema nodosum leprosum

“…The onset of ENL may be of the cutaneous, rheumatoid, or mixed types. The rheumatoid type presents with symmetrical arthritis affecting the small joints of the hands and feet, in the so-called “rheumatoid distribution.”[ 61 ] This has an incidence of more than 57%. [ 62 ] The cutaneous onset is characterized by the classical skin lesions which precede systemic involvement.…”

Leprosy-Related Chronic Arthritis with an Abundance of Mycobacterium Leprae in the Synovial Fluid: A Rare Case

“…5 Furthermore, musculoskeletal problems in leprosy can resemble other connective tissue disorders, which may lead to misdiagnosis and mistreatment. 6 Therefore, it is important for clinicians to have good knowledge about several aspects of this condition. 5 In addition, the examination and early treatment of bone and joint complications can reduce disabilities and deformities in leprosy.…”

Erythema nodosum leprosum as presenting feature of lepromatous leprosy

“…In cases where findings don't present with typical rheumatologic disease, skin biopsy should be performed to rule out destructive diseases such as leprosy and rare presentations such as ENL should be part of the differential. Demonstration of acid-fast bacilli in the dermis is the cornerstone of diagnosis [7][8][9].…”