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

Abstract

Bone and joint involvements are the most common manifestation in leprosy, after cutaneous and neurological manifestations, yet are underdiagnosed and rarely reported. We report a case of lepromatous leprosy in a 41-year-old male with bone and joint changes. Physical examination revealed a leonine face, madarosis, hypesthetic hypopigmented macules on the back, and swelling of fingers and toes. Acid-fast bacilli from slit-skin smear and synovial fluid in an interphalangeal joint of the hand were found. Radiographic features showed osteolysis and destruction of some phalanges of the hands, bone erosion and destruction of some phalanges of the feet, as well as destruction and subluxation of some hand joints. The patient was given multidrug therapy for multibacillary leprosy, resulting in the reduction of swelling in fingers and toes. In conclusion, the examination of bone and joint changes in leprosy patients is important for early detection and management of musculoskeletal complications, to prevent future deformities and disabilities.

Arthritis in Leprosy: A Case Report

“…Charcot arthropathy or neuropathic arthropathy is characterized by joint dislocation, pathological fracture, and severe deformity involving areas of weight-bearing joints such as the ankles and knees. It is estimated that about 10 % of leprosy patients have Charcot arthropathy due to untreated peripheral neuropathy (5,10).…”

“…Fever, exacerbation of skin lesions, and paresthesia predominate in the clinical presentation of type I and II reactions. In acute arthritis due to type I and II reactions, symptoms usually improve within 4 weeks (5,10,11). Painful swelling of the dorsal region of the hand with limited movement can be seen in leprosy patients.…”

“…As a result of this infiltration, irreversible joint damage can occur. The most common permanent damage is boutonniere deformity and swan neck deformity (5,10).…”

Small Finger Proximal Interphalangeal Joint Chronic Arthritis Secondary to Leprosy: A Case Report

“…Leprosy can cause muscle weakness and wasting, nerve damage, joint deformities, bone infections, and immune-mediated reactions that affect the musculoskeletal system. Common joint deformities include claw hand and foot drop [5][6][7][8][9]. Musculoskeletal features sometimes constitute the initial presentation or mimic other connective tissue disorders, which can lead to misdiagnosis and mistreatment [8].…”

“…Common joint deformities include claw hand and foot drop [5][6][7][8][9]. Musculoskeletal features sometimes constitute the initial presentation or mimic other connective tissue disorders, which can lead to misdiagnosis and mistreatment [8].…”