The rheumatic manifestations of leprosy (Hansen disease)

Leprosy is a rare disorder in the United States, yet the rheumatic features of the disease appear to be common and frequently are the primary complaint. We observed rheumatic syndromes of erythema nodosum leprosum (ENL) occurring with and without arthritis, a swollen hands syndrome, cutaneous vasculitis, or myositis in the majority (15 of 21) of our patients. These syndromes were distinctive, sometimes dramatic, and appeared to "mimic" idiopathic rheumatic diseases, substantially delaying an accurate diagnosis of leprosy in some patients. These complications were the major cause of morbidity in our 21 patients and became dominant clinical problems requiring additional chemotherapy.