Henriques Celia Coelho, Lopéz Begoña, Mestre Tiago, Grima Bruno, Panarra António, Riso Nuno
Internal Medicine Department 2, Curry Cabral Hospital, Lisbon, Portugal.
BMJ Case Rep. 2012 Aug 13;2012:bcr1220115346. doi: 10.1136/bcr.12.2011.5346.
Leprosy or Hansen's disease is a chronic granulomatous infectious disease caused by Mycobacterium leprae with a high prevalence in some developing countries however, it is rarely seen in non-endemic regions. Arthritis has been described in all types of Hansen's disease. Chronic arthritis is known to exist even in paucibacillary forms, resolved or treated disease and in patients without reaction, suggesting a perpetuated inflammatory process. In these cases leprosy can mimic some autoimmune diseases such as rheumatoid arthritis. When a patient with a history of leprosy presents with a symmetric, distal, polyarthritis the diagnosis may not be linear. Possibly it is a rheumatoid-like leprous arthritis with M leprae acting as the trigger element for the chronic process or it is an overlap condition, with a concomitant rheumatoid arthritis? A case report of a patient with a chronic inflammatory arthritis with 10 years of evolution is presented. The differential diagnosis between leprous and rheumatoid arthritis is discussed.
麻风病或汉森病是一种由麻风分枝杆菌引起的慢性肉芽肿性传染病，在一些发展中国家高发，然而在非流行地区很少见。所有类型的汉森病都曾有过关节炎的描述。已知慢性关节炎甚至存在于少菌型、已治愈或已治疗的疾病以及无反应的患者中，这表明存在持续的炎症过程。在这些情况下，麻风病可能会模仿一些自身免疫性疾病，如类风湿关节炎。当有麻风病史的患者出现对称性、远端多关节炎时，诊断可能并不明确。可能是类似类风湿的麻风关节炎，麻风分枝杆菌作为慢性病程的触发因素，或者是一种重叠情况，同时伴有类风湿关节炎？本文报告一例患有慢性炎症性关节炎且病程长达10年的患者。并讨论了麻风性关节炎和类风湿关节炎的鉴别诊断。
