title: Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review.
abstract: Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.
authors.affiliation: Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México gabho@hotmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Horta-Baas
authors.affiliation: Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, Estado de México, México.
authors.forename: M F
authors.initials: MF
authors.lastname: Hernández-Cabrera
authors.affiliation: Jefe de Servicio del Departamento de Reumatología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
authors.forename: L A
authors.initials: LA
authors.lastname: Barile-Fabris
authors.affiliation: Coordinación de Investigación en Salud, Delegación Estado de México Poniente, Instituto Mexicano del Seguro Social, Toluca, México.
authors.forename: M del S
authors.initials: Mdel S
authors.lastname: Romero-Figueroa
authors.affiliation: Dermatólogo y Micólogo. Jefe de la Sección de Micología. Departamento de Dermatología. Hospital General Dr Manuel Gea González, Distrito Federal, México.
authors.forename: R
authors.initials: R
authors.lastname: Arenas-Guzmán
mesh_terms: D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007917:Leprostatic Agents / Q000627:therapeutic use; D056006:Leprosy, Multibacillary / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007917:Leprostatic Agents
keywords: Hansen’s disease; Leprosy; mimicking; misdiagnosis; systemic lupus erythematosus