TY - JOUR
T1 - Leprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease
AU - Simeoni, Sara
AU - Puccetti, Antonio
AU - Tinazzi, Elisa
AU - Codella, Orazio Michele
AU - Sorleto, Michele
AU - Patuzzo, Giuseppe
AU - Colato, Chiara
AU - Tessari, Gianpaolo
AU - Lunardi, Claudio
PY - 2011/12
Y1 - 2011/12
N2 - ABSTRACT: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. We describe the case of a 20-year-old man from India living in Italy since 2003, who presented with erythematous papules and nodules distributed on his arms, legs, and face in 2006. He also had episodes of high fever, polyarthritis, and episcleritis. Sarcoidosis was suspected on the basis of elevated angiotensin-converting enzyme and bronchoalveolar lavage fluid, and the patient was treated with corticosteroids for about a year. A flare of the disease occurred each time corticosteroid was tapered or suspended. An autoinflammatory disease was then suspected and treated with immunosuppressant. Only the third deep skin biopsy revealed the presence of M. leprae. The lack of clinical suspicion and the unfamiliarity with the histology of leprosy delayed diagnosis and treatment. Leprosy should be considered in the differential diagnoses of patients presenting with rheumatic and cutaneous manifestations especially when they come from countries where the disease is endemic.
AB - ABSTRACT: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. We describe the case of a 20-year-old man from India living in Italy since 2003, who presented with erythematous papules and nodules distributed on his arms, legs, and face in 2006. He also had episodes of high fever, polyarthritis, and episcleritis. Sarcoidosis was suspected on the basis of elevated angiotensin-converting enzyme and bronchoalveolar lavage fluid, and the patient was treated with corticosteroids for about a year. A flare of the disease occurred each time corticosteroid was tapered or suspended. An autoinflammatory disease was then suspected and treated with immunosuppressant. Only the third deep skin biopsy revealed the presence of M. leprae. The lack of clinical suspicion and the unfamiliarity with the histology of leprosy delayed diagnosis and treatment. Leprosy should be considered in the differential diagnoses of patients presenting with rheumatic and cutaneous manifestations especially when they come from countries where the disease is endemic.
KW - leprosy
KW - sarcoidosis
KW - Still disease
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U2 - 10.1097/RHU.0b013e31823a55e5
DO - 10.1097/RHU.0b013e31823a55e5
M3 - Article
C2 - 22089994
AN - SCOPUS:82455164026
VL - 17
SP - 432
EP - 435
JO - Journal of Clinical Rheumatology
JF - Journal of Clinical Rheumatology
SN - 1076-1608
IS - 8
ER -