Leprosy revelated by articular manifestations

Background: We report a case of leprosy observed in a French woman who had lived in Africa 30 years earlier. The clinical presentation was misleading, suggesting connective tissue disease. Cast report. A 69-year-old woman was hospitalized in April 1996 for inflamm atory joint disease. The first manifestations had developed three years ear lier and the patient had been on systemic corticosteroid therapy associated with anti-malarials since 1993. The clinical presentation progressively in cluded neurological and skin manifestations. Histology examination gave the diagnosis of lepromatous leprosy. Three-drug anti-leprosy treatment in one oral dose was initialed. Discussion: Chronic Mycobacterium leprae infection usually leads to overt l eprosy with neurological and cutaneous involvement. Rheumatological forms a re less common and found almost exclusively during leprous reactions. The a ssociation of inflammatory joint pain with neurological and skin manifestat ions wrongly suggested vasculitis. In addition, the general corticosteroid therapy certainly was implicated in disease activation and progression to a purely lepromatous form.