Delayed diagnosis of leprosy due to presentation with a rheumatoid-like polyarthropathy

Abstract

Conflict of interest: none declared Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae and principally affecting the nerves and skin. Musculoskeletal symptoms such as arthritis are the third most common presenting manifestation of leprosy, after neurological and cutaneous features, and can mimic more common disorders such as rheumatoid arthritis (RA). We report a case of borderline lepromatous leprosy in which arthritis preceded the development of cutaneous and neurological signs, and led to subsequent delay in diagnosis. A 70‐year‐old Chinese man presented with a 6‐week history of multiple erythematous plaques on the face and lower limbs (Fig. 1a). He had been diagnosed with seronegative RA 2 years previously when he presented with symmetrical peripheral synovitis affecting his hands, wrists, knees and ankles. This was treated with oral prednisolone and methotrexate. He had emigrated from Hong Kong 40 years previously, and had only returned for one 2‐week visit 3 years before the onset of his arthritis. There was no other history of foreign travel.