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Chronic inflammatory joint disease revealing borderline leprosy
Mohamed Imed Miladi1, Imed Feki, Zouhir Bahloul
1Neurology Department, Habib Bourguiba Teaching Hospital, Sfax, Tunisia.
Joint Bone Spine
|October 11, 2005
Summary
Leprosy can initially mimic rheumatoid arthritis with musculoskeletal symptoms. Early diagnosis is crucial, as treatment improved inflammatory markers but not established nerve damage in this case.
Area of Science:
- Rheumatology
- Neurology
- Infectious Diseases
Background:
- Musculoskeletal symptoms in leprosy can present insidiously, mimicking other inflammatory arthropathies like rheumatoid arthritis.
- Differentiating early leprosy from rheumatoid arthritis is clinically challenging due to overlapping symptoms.
Observation:
- A 24-year-old man presented with a 5-year history of intermittent inflammatory arthritis and fever, initially with normal physical and radiographic findings.
- Over time, he developed severe hand muscle wasting, stocking-glove sensory loss, hand burn scars, and plantar ulcers.
- Nerve biopsy revealed endoneurial inflammatory infiltrates, and a family history of leprosy was uncovered.
Findings:
- Electrophysiological studies indicated a sensory-motor neuropathy with predominant demyelination.
- Laboratory tests showed inflammation without immunological abnormalities.
- Treatment with dapsone, clofazimine, and rifampin led to improvement in joint manifestations and inflammatory markers.
Implications:
- This case highlights the diagnostic challenge of leprosy presenting as inflammatory arthritis.
- Prompt recognition and treatment are essential to manage leprosy's systemic manifestations.
- While treatment can control inflammation, established neurological deficits may not be reversible.
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