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

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The authors have no conflicts of interest to disclose.

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