Lepromatous leprosy mimicking systemic lupus erythematosus

M M P T Jayasekera,R A N K Wijesinghe,I H S Kumarasinghe,T M J Munasinghe,T Samarawickrama,T A S L Karunarathna,B G D S Govindapala

doi:10.4038/jccp.v52i1.7930

Abstract

We describe a case of a 36-year-old woman who presented with bilateral symmetrical polyarthritis of the hands, malar rash, and discoid rash over three months. She was initially diagnosed and treated as systemic lupus erythematosus but later proven to have lepromatous leprosy. The patient showed a remarkable improvement after the administration of steroids. Due to typical features of a connectivetissue disorder, a positive serological marker, photosensitivity, typical age of onset and initial response to treatment led to the confusion and delay in diagnosis of lepromatous leprosy. Further, this case emphasizes the importance of obtaining a detailed contact history and taking a skin biopsy even in a typical connective tissue lesion. Our case illustrates an unusual presentation of lepromatous leprosy mimicking systemic lupus erythematosus.

Highlights

Leprosy, known as Hansen disease, is a chronic infectious disease caused by mycobacterium leprae
The skin biopsy had moderate to large number of acid-fast organisms within the foamy histiocytes keeping with borderline lepromatous leprosy (Figure 3,4)
Arthritis due to leprosy can be divided into four types: Charcot joints, septic arthritis, acute polyarthritis of lepra reaction and chronic arthritis resembling rheumatoid arthritis.[4]

Summary

Introduction

Known as Hansen disease, is a chronic infectious disease caused by mycobacterium leprae. A skin biopsy from her upper arm was sent for histology She was symptomatic with painful arthritis and a desquamation rash over both soles. She fulfilled the criteria for diagnosis of SLE and was started on aceclofenac sodium 100 mg twice a day, hydroxychloroquine 200 mg daily and prednisolone 30 mg daily. The skin biopsy had moderate to large number of acid-fast organisms within the foamy histiocytes keeping with borderline lepromatous leprosy (Figure 3,4). She was referred to the dermatology clinic for the commencement of multidrug therapy.

Findings

Discussion

Conclusion