title: Delay in diagnosis: indeterminate leprosy presenting with rheumatic manifestations.
abstract: BACKGROUND
  Rheumatic complications are common in leprosy (Hansen's disease) and can be the primary complaint delaying accurate diagnosis.
  
  
  OBJECTIVE
  Such a case is reported here: a 61-year-old woman with indeterminate leprosy presented with symmetric arthritis and purpura. Despite biopsy and evaluation by several physicians, leprosy was not suspected. After 2 years of progressive symptoms, a second biopsy revealed lepromatous leprosy.
  
  
  CONCLUSIONS
  In this case, lack of clinical suspicion and unfamiliarity with the histology of indeterminate leprosy delayed diagnosis and treatment. Leprosy should be considered in the differential diagnosis of patients presenting with unusual rheumatic and persistent cutaneous manifestations.
authors.affiliation: Division of Dermatology and Dermatopathology, Department of Pathology, Albany Medical College A-81, Albany, NY 12208, USA.
authors.forename: P
authors.initials: P
authors.lastname: Sadeghi
authors.forename: M
authors.initials: M
authors.lastname: Dupree
authors.forename: J A
authors.initials: JA
authors.lastname: Carlson
mesh_terms: D001168:Arthritis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015440:Leprosy, Lepromatous / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D013997:Time Factors