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

Leprosy 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...

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Bibliographic Details
Published in:	BMC infectious diseases Vol. 19; no. 1; p. 455
Main Authors:	Guerra, Miguel Gomes, Videira, Taciana Marta Ferreira Cardoso, Morais, Hugo Alexandre Gomes, Santos, Telma Cristiana Resse Nunes, Taipa, Ricardo Jorge Ferreira, Abreu, Miguel Araújo, Vieira, Romana Carisa Carvalho, da Fonseca, Diogo Miranda Gonçalves Guimarães, Dos Santos, Joana Patrícia Abelha Aleixo, Pinto, Sandra Patrícia Abreu Monteiro
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 22-05-2019 BioMed Central BMC
Subjects:	Amyloid Arthralgia Arthritis Bacilli Biopsy Case Report Case reports Causes of Complications and side effects Corrosion Diagnosis Disease Edema Glucocorticoids Heterogeneity Infectious diseases Leprosy Lesions Literature reviews Lupus Methotrexate Nervous system Pathogens Peripheral nerves Peripheral neuropathy Polyneuropathies Polyneuropathy Prednisone Prostate Remitting seronegative symmetrical synovitis with pitting Oedema syndrome Rheumatic diseases Rheumatology Skin Skin diseases Synovitis Tuberculosis Ultrasonic imaging Portugal Leprosy Peripheral neuropathy Remitting seronegative symmetrical synovitis with pitting Oedema syndrome
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Summary:	Leprosy 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. A 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. This 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.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1471-2334 1471-2334
DOI:	10.1186/s12879-019-4098-9