Rheumatoid arthritis
Development of Leprosy in a Patient with Rheumatoid Arthritis During Treatment with Etanercept: A Case Report

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Background

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder. There is a clear association between some disease-modifying drugs used to treat RA and infection. The introduction of the anti-tumor necrosis factor (TNF) therapies has improved the outcome of severe RA. The TNF-antagonism may increase susceptibility to granulomatous pathogens such as Mycobacterium tuberculosis, Listeria monocytogenes, and Histoplasma capsulatum.

Methods

We report the case of a 37-year-old woman with RA receiving an anti-TNF agent, who developed a rash on her back and both legs, which was finally diagnosed as tuberculoid leprosy.

Results

This is the first case of leprosy due to anti-TNF therapy reported in Europe.

Conclusions

Clinicians should be aware of this and other types of atypical and serious infections that patients may suffer from when treated with anti-TNF agents.

Section snippets

Case Report

A 37-year-old woman from Bolivia came to our rheumatology consultation complaining of several months of arthralgia and weakness followed by joint inflammation of extremities during the last months. She had been living in Spain since 2005; the rest of her medical history was unremarkable. On presentation, her physical examination revealed a slightly pale-appearing and pale conjunctivae, symmetrical polyarthritis that affected the hands and feet, and also rheumatoid nodules in the inner forearms;

Discussion

Leprosy can be a difficult disease to diagnose outside its endemic areas. The natural history of this disease is poorly understood and only a minority of those who come into contact with the mycobacteria, <1%, develop clinical disease (2). In addition, the disease has a long incubation period (2 to 11 years), and patients may have left the endemic area a long time ago when they first present the symptoms and signs of leprosy (3).

Leprosy is a chronic granulomatous disease caused by infection

References (16)

  • O.Y. Saliu et al.

    Tumor-necrosis-factor blockers: Differential effects on mycobacterial immunity

    J Infect Dis

    (2006)
  • J.L. Casanova et al.

    Genetic dissection of immunity to mycobacteria: The human model

    Annu Rev Immunol

    (2002)
  • D.N. Lockwood et al.

    The diagnosis of leprosy is delayed in the United Kingdom

    QJM

    (2001)
  • H.M. Algood et al.

    Tumor necrosis factor and chemokine interactions in the formation and maintenance of granulomas in tuberculosis

    Clin Infect Dis

    (2005)
  • S. Ehlers

    Tumor necrosis factor and its blockade in granulomatous infections: Differential modes of action of infliximab and etanercept?

    Clin Infect Dis Off Publ Infect Dis Soc Am

    (2005)
  • W.G. Dixon et al.

    Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: Results from the British Society for Rheumatology Biologics Register (BSRBR)

    Ann Rheum Dis

    (2010)
  • C.A. Dinarello

    Differences between anti-tumor necrosis factor-alpha monoclonal antibodies and soluble TNF receptors in host defense impairment

    J Rheumatol Suppl

    (2005)
  • W.G. Dixon et al.

    Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: Results from the British Society for Rheumatology Biologics Register (BSRBR)

    Ann Rheum Dis

    (2010)
There are more references available in the full text version of this article.

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The authors have no conflicts of interest to disclose.

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