Moulick A, Jana A, Sarkar N, Guha P, Mahapatra C, Lallawmzuala K
Department of Medicine, Calcutta National Medical College, 24 Gorachand Road, Kolkata-700014, India.
Indian J Lepr. 2013 Apr-Jun;85(2):83-6.
Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. Predominantly involving skin and nerves and having classic clinical description, the diagnosis may be clear-cut in majority of patients but may be challenging in others. Non-pitting edema, ichthyosis and arthritis are uncommon in leprosy and very rare in tuberculoid type where the diagnosis may be challenging unlike relatively clear-cut clinical picture in lepromatous type. Musculoskeletal manifestation is seen in 1-5% of cases and usually associated with reactional states where again the diagnosis sometimes becomes evident. High index of suspicion is therefore recommended in patients with unexplained systemic illness especially in endemic areas. Herein we report a young male with non pitting edema and symmetric peripheral arthritis involving all four limbs, and ichthyosis as presenting manifestation of borderline leprosy where the neuro-cutaneous manifestation developed two months after the said presenting features and in absence of a reactional state.
麻风是由麻风分枝杆菌引起的一种慢性肉芽肿性感染。主要累及皮肤和神经，具有典型的临床特征，大多数患者的诊断可能明确，但对其他患者而言可能具有挑战性。非凹陷性水肿、鱼鳞病和关节炎在麻风患者中并不常见，在结核样型中极为罕见，该型的诊断可能具有挑战性，不像瘤型麻风那样有相对明确的临床表现。肌肉骨骼表现见于1%至5%的病例，通常与反应状态相关，而这种情况下诊断有时也会变得明显。因此，对于患有不明原因全身性疾病的患者，尤其是在流行地区，建议保持高度警惕。在此，我们报告一名年轻男性，其以非凹陷性水肿、累及四肢的对称性外周关节炎和鱼鳞病作为界线类麻风的表现，在上述表现出现两个月后且无反应状态的情况下出现了神经皮肤表现。
