Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report

BMC Infectious Diseases

Hugo Alexandre Gomes Morais¹  Telma Cristiana Resse Nunes Santos¹  Joana Patrícia Abelha Aleixo dos Santos²  Taciana Marta Ferreira Cardoso Videira²  Diogo Miranda Gonçalves Guimarães da Fonseca²  Romana Carisa Carvalho Vieira²  Sandra Patrícia Abreu Monteiro Pinto²  Miguel Gomes Guerra²  Miguel Araújo Abreu³  Ricardo Jorge Ferreira Taipa⁴ 

[1] 0000 0000 8902 4519, grid.418336.b, Department of Neurology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal;0000 0000 8902 4519, grid.418336.b, Department of Rheumatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal;0000 0001 1503 7226, grid.5808.5, Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, 4099-001, Porto, Portugal;0000 0001 1503 7226, grid.5808.5, Neuropathology Unit, Department of Neuroscience, Centro Hospitalar Universitário do Porto, 4099-001, Porto, Portugal;

关键词: Leprosy;    Remitting seronegative symmetrical synovitis with pitting Oedema syndrome;    Peripheral neuropathy;   

DOI  :  10.1186/s12879-019-4098-9

来源: publisher

【 摘 要 】

BackgroundLeprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy.Case reportA 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy.ConclusionThis report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.

【 授权许可】

CC BY