Leprosy often presents as a rheumatologic disorder including
lupus erythematosus,1,2 rheumatoid arthritis
(RA),3 or anticardiolipin syndrome.4 We report a case of
a leprosy patient treated in a New Jersey Rheumatology clinic
for two years with Prednisone 5mg daily, Methotrexate 25mg
every week, and Naproxen 500mg every day. During her treatment
for RA, an infiltrative dermopathy developed. A skin biopsy
revealed fite-positive multibacillary leprosy and the patient
was referred to the New York Hansen Disease Program
at Bellevue Hospital. The patient was started on US multi-drug
therapy5 and thalidomide (100mg BID). During her course of
treatment the rheumatoid factor became negative and thalidomide
was reduced to as little as 50mg every other day with
amelioration of her arthritis and gradual flattening of her infiltrative
dermopathy. In the age of biologics,3,6 it is important that
clinicians be aware that leprosy can present as RA, and other
Rheumatoid Arthritis and other autoimmune disorders such
as lupus and antiphospholipid syndrome are commonly presented
in leprosy patients, on the order of 25% of BL cases.7 It is important that physicians confronted with autoimmune
disorders consider leprosy and the differential diagnosis and
have an index of suspicion to order a skin biopsy with a fite
stain. Undetected cases are detrimental to leprosy patients due
to the possible contractures and loss of sensation that occur
in leprosy. It is important that physicians not put patients on
immunosuppressive agents such as methotrexate and biologics
for thalidomide is the treatment of choice when patients
present with Type II ENL. Continued lack of awareness by physicians
in the US will lead to autochthonous cases of leprosy
such as cases that have been reported in New York City.8
The authors have no conflicts.
- Alberti JR, Cabrera A, Martiniuk F, Sanchez M, Levis WR. Leprosy masquerading as lupus. J AM Acad Dermatol. 2005;52(4):702-3. PMID: 15793528
- Karadeniz A, Lally L, Magro C, Levy R, Erkan D, Lockshin MD. Lepromatous leprosy mimicking systemic lupus erythematosus: a clinical pathology conference held by the division of rheumatology at hospital for special surgery. HSS J. 2014;10(3):286-91.
- Rath D, Bhargava S, Kundu BK. Leprosy mimicking common rheumatologic entities: a trial for the clinician in the era of biologics. Case Rep Rheumatol. 2014; 429698.
- Kaliyadan F, Bhaskaran M, Dharmaratnam AD, Manoj J, Sreekanth G. Anti-phospholipid syndrome preceding a diagnosis of lepromatous leprosy. Dermatol Online J. 2009;15(6):4.
- National Hansen’s Disease Program (NHDP). www.hrsa.gov/hansensdisease
- Scollard DM¹, Joyce MP, Gillis TP. Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases. Clin Infect Dis. 2006;43(2):e19-22.
- Garcia-De La Torre L. Autoimmune phenomena in leprosy, particularly antinuclear antibodies and rheumatoid factor. J Rheumatol. 1993;20(5);900-3.
- Keo T, Martinuk F, Latkowski J, Cabrera A, Rom W, Levis WR. Molecular origin of endemic leprosy in New York City. Clin Infect Dis. 2008;15;46(6):899-901.