Rheumatoid arthritisDevelopment of Leprosy in a Patient with Rheumatoid Arthritis During Treatment with Etanercept: A Case Report
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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Cited by (20)
Opportunistic tropical infections in immunosuppressed patients
2020, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Some immunosuppressed patients develop multibacillary forms. Other reports related to other autoimmune diseases, mainly RA, have demonstrated the development of paucibacillary forms [66,67] or leprosy reactions [64,67]. Leprosy reactions are characterized by malaise and exacerbation of preexisting lesions usually accompanied by neuritis edema, occurring in 40% of borderline patients [64].
Mycobacteria
2016, Tropical Dermatology: Second EditionThe -308 bp TNF gene polymorphism influences tumor necrosis factor expression in leprosy patients in Bahia State, Brazil
2016, Infection, Genetics and EvolutionCitation Excerpt :The resulting rationale is that high levels of proinflammatory TNF associated with carriage of the A allele would be detrimental in the context of autoimmune diseases and enhanced pro-inflammatory responses in infections like malaria, leprosy and cutaneous leishmaniasis (Bayley et al., 2004). Balancing this is the requirement for TNF in the activation of macrophages to kill mycobacteria, as evidenced by reactivation of mycobacterial infections, including leprosy (Lluch et al., 2012), following treatment of autoimmune disease patients with anti-TNF antibodies. Hence, the alternative hypothesis that protection from leprosy associated with the minor A allele could be due to the requirement for TNF to control leprosy infection.
Infectious Arthritis and Osteomyelitis
2015, Textbook of Pediatric RheumatologyLeprosy and Autoimmunity
2015, Infection and AutoimmunityMycobacterium leprae (Leprosy)
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
The authors have no conflicts of interest to disclose.