Leprosy with Atypical Skin Lesions Masquerading as Relapsing Polychondritis

Abstract

Leprosy can present with a variety of clinical manifestations depending on the immune status of the individual. After dermatological and neurological involvement, rheumatic features specially various forms of arthritis are the third most common manifestation of the disease. We describe a unique case of a 22-year-old patient presenting with external ear involvement mimicking relapsing polychondritis along with inflammatory joint symptoms and skin lesions. Ear involvement in relapsing polychondritis characteristically is painful and spares the noncartilaginous ear lobules, in contrast to painless ear involvement in leprosy affecting the lobules as well. Histopathology confirmed the diagnosis, although the ear and skin lesions were not classical of leprosy. Such a presentation of leprosy closely mimicking relapsing polychondritis has not been described previously. Tissue diagnosis should always be attempted whenever possible in patients presenting with autoimmune features, so that inappropriate therapy with immunosuppressants is avoided.

Isolated Bilateral Pinna Swelling: A Rare Initial Presentation of Leprosy

“…Leprosy has a systemic involvement of the dermatological, neurological and rheumatological systems [3]. Due to its systemic manifestations, it is difficult to differentiate leprosy from other systemic diseases.…”

Refractory relapsing polychondritis: challenges and solutions

“…Skin biopsy helps the diagnosis by showing a granuloma with the presence of acid-fast bacilli. 43 Otherwise, a specific relationship exists between relapsing polychondritis and myelodysplastic syndromes. Myelodysplastic syndromes occur in approximately 8–40% of patients with relapsing polychondritis, mostly in men over 60 years of age.…”

“… 1 – 5 Their addition is necessary to control the disease activity or to spare corticosteroid dose and adverse events. 43 Among these, colchicine, dapsone, methotrexate, cyclophosphamide, cyclosporine, chlorambucil, azathioprine, mycophenolate mofetil, intravenous immunoglobulin, minocycline, and leflunomide have been shown to be effective in some patients. 3 , 44 Colchicine may be useful during remission phases of relapsing polychondritis.…”

Serpentine Lesion on the Leg; Another Face of Hansen’s Disease

“…2,3 Leprosy can be diagnosed fairly accurately on the basis of three signs, which include hypoesthesia, skin lesions and thickened nerves. 4 The uncommon disease presentations include localised lepromatous disease presenting with single nodule or localised area of papules and nodules, histoid leprosy, lucio leprosy and spontaneous ulcerations in longstanding untreated lepromatous leprosy. Uncommon presentations are hard to diagnose clinically.…”