Department of Medicine, University of Verona, Verona, Italy.
J Clin Rheumatol. 2011 Dec;17(8):432-5. doi: 10.1097/RHU.0b013e31823a55e5.
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.
麻风是由麻风分枝杆菌引起的一种慢性肉芽肿性疾病。我们描述了一个 20 岁的印度男性的病例，他自 2003 年起生活在意大利，2006 年出现分布于手臂、腿部和面部的红斑丘疹和结节。他还伴有高热、多发性关节炎和巩膜炎。根据血管紧张素转换酶升高和支气管肺泡灌洗液，怀疑为结节病，患者接受了大约一年的皮质类固醇治疗。每次皮质类固醇减量或停药时，疾病都会复发。随后怀疑为自身炎症性疾病，并接受免疫抑制剂治疗。只有第三次深部皮肤活检显示存在麻风分枝杆菌。由于临床怀疑不足和对麻风病组织学的不熟悉，导致诊断和治疗延迟。对于出现风湿和皮肤表现的患者，特别是来自麻风病流行地区的患者，应考虑进行麻风病的鉴别诊断。
