title: Lepromatous leprosy masquerading as acute sarcoidosis: a case report and literature review.
abstract: Leprosy is uncommon in North America. Because it has a prolonged incubation period and can masquerade with a variety of manifestations, many patients with leprosy experience a significant delay in diagnosis and treatment. Lepra reactions are of 2 types: reversal (type 1) and erythema nodosum leprosum (ENL) (type 2). Type 1 or reversal reactions represent an increase in cell-mediated immunity, whereas type 2 or ENL is caused by antigen-antibody complex formation and deposition after antigen release from dying lepra bacilli. This article describes the diagnostic challenges presented by a Minnesota patient eventually found to have lepromatous leprosy. That challenge was compounded by the fact that the clinical scenario closely mimicked connective tissue/immune complex disease and by the fact that the patient presented in a location where the incidence and prevalence of leprosy is extremely low.
authors.affiliation: Department of Internal Medicine, University of Minnesota, USA.
authors.forename: Mrinal M
authors.initials: MM
authors.lastname: Patnaik
authors.forename: Dale
authors.initials: D
authors.lastname: Hammerschmidt
authors.forename: Jo-Anne H
authors.initials: JA
authors.lastname: van Burik
authors.forename: Jose
authors.initials: J
authors.lastname: Jessurun
authors.forename: Peter
authors.initials: P
authors.lastname: Smyth
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D004893:Erythema Nodosum / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D015440:Leprosy, Lepromatous / Q000175:diagnosis* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D012507:Sarcoidosis / Q000175:diagnosis* / Q000473:pathology; D012867:Skin / Q000473:pathology