title: Leprosy initially misdiagnosed as sarcoidosis, adult-onset still disease, or autoinflammatory disease.
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.
authors.affiliation: Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Simeoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Puccetti
authors.forename: Elisa
authors.initials: E
authors.lastname: Tinazzi
authors.forename: Orazio Michele
authors.initials: OM
authors.lastname: Codella
authors.forename: Michele
authors.initials: M
authors.lastname: Sorleto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Patuzzo
authors.forename: Chiara
authors.initials: C
authors.lastname: Colato
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Tessari
authors.forename: Claudio
authors.initials: C
authors.lastname: Lunardi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D007918:Leprosy / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009166:Mycobacterium leprae / Q000302:isolation & purification*; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones