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Zhao C, Liu Z. A case report and literature review: Mycobacterium leprae infection diagnosed by metagenomic next-generation sequencing of cerebrospinal fluid. BMC Infect Dis 2024; 24:666. [PMID: 38961391 PMCID: PMC11223277 DOI: 10.1186/s12879-024-09473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) that is responsible for deformities and irreversible peripheral nerve damage and has a broad spectrum of clinical and serological manifestations. Leprosy primarily affects the peripheral nerves and rarely presents with central nervous system involvement. Diagnosing leprosy can still be difficult in some cases, especially when the infection involves uncommon clinical manifestations and extracutaneous sites. Delayed diagnosis and treatment of leprosy may lead to irreversible damage and death. CASE PRESENTATION We report a case of a 30-year-old female presenting with "repeated high fever with symptoms of headache for 14 days". On the day of admission, physical signs of lost eyebrows and scattered red induration patches all over her body were observed. The patient's diagnosis was based on the clinical characteristics using a combination of metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and slit-skin smear. After confirming Listeria meningitis and multibacillary leprosy with erythema nodosum leprosum (ENL), a type 2 reaction, she was treated with ampicillin sodium, dapsone, rifampicin, clofazimine, methylprednisolone, and thalidomide. At the 1-year follow-up, the frequency and severity of headaches have significantly decreased and a good clinical response with improved skin lesions was found. CONCLUSION This case highlights the importance of considering leprosy, which is a rare and underrecognized disease, in the differential diagnosis of skin rashes with rheumatic manifestations, even in areas where the disease is not endemic, and physicians should be alerted about the possibility of central nervous system infections. In addition, mNGS can be used as a complementary diagnostic tool to traditional diagnostic methods to enhance the diagnostic accuracy of leprosy.
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Affiliation(s)
- Conglin Zhao
- Center of Infectious Diseases, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China
| | - Zhenzhen Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
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Long-term presence of autoantibodies in plasma of cured leprosy patients. Sci Rep 2023; 13:228. [PMID: 36604576 PMCID: PMC9816311 DOI: 10.1038/s41598-022-27256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Autoantibodies have been detected in leprosy patients, indicating that infection with M. leprae may lead to autoimmune disorders. However, whether autoimmune response last until patients are cured is unknown. Knowing the autoimmune response in cured leprosy patients is essential to identify whether symptoms are caused by leprosy itself or by other immune-related diseases. This knowledge is essential for the ongoing health management in cured leprosy patients where autoimmune disorders still exist. In our study, we selected six autoantibodies, including anticardiolipin antibody of IgG (ACA), anti-nuclear antibody (ANA), extractable nuclear antigen antibody (ENA), anti-streptolysin O (ASO), anti-double stranded DNA antibody (dsDNA), and rheumatoid factor (RF), that had been reported in leprosy patients as typical autoantibodies. We tested the six typical autoantibodies combined with LACC1, which encodes a protein associated with autoimmune disease such as Crohn's disease and is also the susceptible gene conferring leprosy risk, in cured leprosy patients through ELISA to assess the cured patient's immune status. We observed high positive rates of autoantibodies in cured leprosy patients, and the average plasma levels of five (ACA, ANA, ENA, ASO, and RF) out of the six autoantibodies were significantly higher in cured leprosy patients than in controls. The positive detection of autoantibodies is independent of the recovery period. Moreover, the level of these autoantibodies showed a strong positive correlation with the level of LACC1 in both controls and cured patients. This study showed that there is long-term autoimmunological activation in leprosy patients, even after decades of recovery. Autoimmune responses may influence the development and prognosis of leprosy. Special care should be given to posttreatment or cured leprosy patients regarding long-term autoimmunological activation.
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Sridana ME, Kurniari PK, Kambayana G. Leprosy Mimicking as Rheumatoid Arthritis: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which mainly damages the skin and peripheral nerves, and can also infect joints and bones. Clinical manifestations are complex, varied, and often underdiagnosed. The clinical manifestations vary and are called "the great imitator". musculoskeletal features are common in leprosy but infrequently reported. A case of borderline lepromatous (BL) type leprosy was initially suspected as rheumatoid arthritis in a 20-year-old Balinese male who complained of pain and swelling in small joints, accompanied by lesions in the form of multiple erythema macules, round-shaped geography, indistinct boundaries, with bilateral distribution is almost symmetrical in the face, thoracoabdominal, and extremity regions. The diagnosis of BL type leprosy is based on history taking, physical examination, and investigations in the form of Ziehl-Neelsen stain and blood tests.
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Gupta S, Li C, Thallapally VK, Sharma P, Nahas J. Chronic Hand Swelling and Dactylitis in Leprosy: A Case Report and Review of the Literature. Cureus 2021; 13:e13451. [PMID: 33767935 PMCID: PMC7983738 DOI: 10.7759/cureus.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Leprosy is an infectious disease that is associated with various types of presentations. Diagnosis of the disease can be tricky in cases of atypical presentations. We report a unique case of leprosy characterized by chronic hand swelling, dactylitis, and seropositive laboratory markers, which was diagnosed in a rheumatology clinic.
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Affiliation(s)
- Sonia Gupta
- Internal Medicine, Creighton University, Omaha, USA
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Case for diagnosis. Infiltrated areas on the trunk. An Bras Dermatol 2020; 95:652-654. [PMID: 32651045 PMCID: PMC7562998 DOI: 10.1016/j.abd.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open
Abstract
Leprosy is an infectious disease with chronic evolution, caused by Mycobacterium leprae, an acid-fast bacillus that mainly affects the skin and peripheral nervous tissue. Many of the clinical manifestations of leprosy can mimic connective tissue diseases. The authors present the case of a 49-year-old woman who had been treated for four years for systemic lupus erythematosus in a rheumatological service. Skin biopsy of a plaque on the inguinal region was compatible with borderline lepromatous leprosy associated with a type 1 lepra reaction. The patient is undergoing treatment with multibacillary multidrug therapy, showing clinical improvement.
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Abstract
RATIONALE Hansen disease is an infectious chronic disease with various clinical manifestations. Its joint performance may easily mimic rheumatoid arthritis. PATIENT CONCERNS We report a case of a 57-year-old woman diagnosed with Hansen disease 10 years ago, who suffered from joints swelling, pain and joints deformities of both hands for 19 years. The skin on the hands showed rashes, thickening, desquamation and chapping, with both thenar muscles atrophy. She also had severe hypoalgesia of the whole body, and morning stiffness for one hour. DIAGNOSES The final diagnosis was joint damage and peripheral neuropathy due to Hansen disease. INTERVENTIONS The patient received neurotrophic treatment instead of anti-rheumatic treatment. OUTCOMES At 1-year follow up, no further aggravation of joint swelling and pain was detected. LESSONS The correct diagnosis of Hansen disease involving joints depends on the combination of medical history, careful physical examination, and laboratory examination.
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Labuda SM, Schieffelin JS, Shaffer JG, Stryjewska BM. Hansen's Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States. Am J Trop Med Hyg 2017; 97:1726-1730. [PMID: 29141716 DOI: 10.4269/ajtmh.17-0197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hansen's Disease (HD) is a rare, chronic granulomatous infection of the skin and peripheral nerves caused by the noncultivable organism Mycobacterium leprae. Arthritis is the third most common symptom of HD. Subjects with both confirmed HD on skin biopsy and chronic arthritis were identified at the National Hansen's Disease Program (NHDP). We conducted a series of medical chart reviews and extracted and logged personally deidentified data into a database and carried out descriptive analyses. Eighteen of 261 subjects presented to the NDHP with both HD and chronic arthritis between 2001 and 2015. Among these, 16 were male, 16 were white, and 15 were residents of Louisiana. The median age at diagnosis of HD was 67 years. Ten of these subjects were diagnosed with borderline lepromatous leprosy, seven were diagnosed with lepromatous, and one was diagnosed with borderline tuberculoid leprosy. Patients were symptomatic with arthritis for a median of 5.3 years before HD diagnosis. Sixty-two percent of patients (11) were diagnosed with rheumatoid arthritis (RA) before HD diagnosis, and 10 of which were seronegative RA. Hands, feet, wrists, and elbows were most commonly reported as affected joints. Over half of the patients (61%) had completed HD multidrug therapy at the time of review, and 73% of these subjects had persistent joint pain requiring steroids or methotrexate for symptomatic control. Chronic arthritis in HD patients is present in a series of US-acquired cases of HD. Arthritis did not resolve with successful treatment of HD in most cases.
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Affiliation(s)
- Sarah M Labuda
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Jeffrey G Shaffer
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Nagappa M, Chickabasaviah YT, Mahadevan A, Parthiban R, Taly AB. Pitfalls in the diagnosis of leprous neuropathy: Lessons learnt from a University hospital in an endemic zone. J Neurol Sci 2015; 357:252-6. [DOI: 10.1016/j.jns.2015.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 01/30/2023]
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Horta-Baas G, Hernández-Cabrera MF, Barile-Fabris LA, del S Romero-Figueroa M, Arenas-Guzmán R. Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review. Lupus 2015; 24:1095-1102. [DOI: 10.1177/0961203315574557] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.
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Affiliation(s)
- G Horta-Baas
- Servicio de Reumatología, Hospital General Regional 220, Instituto Mexicano del Seguro Social, Toluca, Estado de México, México
| | - M F Hernández-Cabrera
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, Estado de México, México
| | - L A Barile-Fabris
- Jefe de Servicio del Departamento de Reumatología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México
| | - M del S Romero-Figueroa
- Coordinación de Investigación en Salud, Delegación Estado de México Poniente, Instituto Mexicano del Seguro Social, Toluca, México
| | - R Arenas-Guzmán
- Dermatólogo y Micólogo. Jefe de la Sección de Micología. Departamento de Dermatología. Hospital General Dr Manuel Gea González, Distrito Federal, México
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Dionello CF, Rosa Utiyama SR, Radominski SC, Stahlke E, Stinghen ST, de Messias-Reason IJ. Evaluation of rheumatoid factor and anti-citrullinated peptide antibodies in relation to rheumatological manifestations in patients with leprosy from Southern Brazil. Int J Rheum Dis 2015; 19:1024-1031. [PMID: 26250118 DOI: 10.1111/1756-185x.12668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Leprosy patients may present several osteoarticular complaints, which require further evaluation of inflammatory diseases, such as rheumatoid arthritis (RA). Therefore, an adequate clinical assessment in addition to testing for rheumatoid factors (RF) and anticyclic citrullinated peptide antibodies (anti-CCP), can be useful in order to establish the correct diagnosis. METHOD In this study, the relation of RF and anti-CCP with rheumatological manifestations was evaluated in 97 leprosy patients from Southern Brazil. The results were compared to RA patients and healthy controls from the same geographical area and ethnic background. RESULTS Neuropathy was observed in 71.1% and arthritis in 35.1% of the leprosy patients. A high frequency of RF positivity was observed among the leprosy patients (41.2%, 40/97), with RF immunoglobulin A (IgA) significantly associated with arthritis (OR = 7.9, 95% CI = 1.5-40.6 P = 0.008). Anti-CCP was observed in 9.3% (9/97) of the patients, with anti-CCP2 being the most frequent subtype. Only 4.1% (4/97) of the patients were RF and anti-CCP concomitantly positive. RF IgM showed a significant association with leprosy when compared to healthy controls (P < 0.0001) whereas for anti-CCP2 no significant results were observed (P = 0.0585). However, both biomarkers showed a strong association with RA when compared to leprosy in patients from the same geographical area and ethnic background (anti-CCP2 OR = 38.6; 95% CI = 16.49-90.26; P < 0.0001 and RF IgM OR = 4.51; 95% CI = 2.62-7.77; P < 0.0001). CONCLUSION Due to the similarity of some rheumatological manifestations in leprosy with other inflammatory diseases, such as RA, clinical and laboratorial evaluation of affected patients must be carefully assessed in order to achieve proper diagnosis and treatment.
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Affiliation(s)
- Carla Fontoura Dionello
- Laboratório de Imunopatologia, Departamento de Patologia Médica, Clinical Hospital of Federal University of Parana, Curitiba, Brazil
| | - Shirley Ramos Rosa Utiyama
- Laboratório de Imunopatologia, Departamento de Patologia Médica, Clinical Hospital of Federal University of Parana, Curitiba, Brazil
| | | | - Ewalda Stahlke
- Setor de Dermatologia, Centro Regional de Especialidades Metropolitano de Curitiba, Curitiba, Brazil
| | - Servio Tulio Stinghen
- Laboratório de Imunopatologia, Departamento de Patologia Médica, Clinical Hospital of Federal University of Parana, Curitiba, Brazil
| | - Iara Jose de Messias-Reason
- Laboratório de Imunopatologia, Departamento de Patologia Médica, Clinical Hospital of Federal University of Parana, Curitiba, Brazil.
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Rheumatic and other musculoskeletal manifestations and autoantibodies in childhood and adolescent leprosy: significance and relevance. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chopra A. Rheumatic and other musculoskeletal manifestations and autoantibodies in childhood and adolescent leprosy: significance and relevance. J Pediatr (Rio J) 2014; 90:431-6. [PMID: 24973468 DOI: 10.1016/j.jped.2014.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 11/28/2022] Open
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Curi PF, Villaroel JS, Migliore N, Albertengo A, Aquino ML, Ceccato F, Paira S. Lucio's phenomenon: report of five cases. Clin Rheumatol 2014; 35:1397-401. [PMID: 24863848 DOI: 10.1007/s10067-014-2683-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 11/25/2022]
Abstract
The different clinical forms of leprosy are mainly related to the variety of immunological responses to the infection. Several forms of lepromatous leprosy are recognized, including macular, nodular, and diffuse. Lucio's phenomenon is a rare but distinctive skin eruption seen in patients with diffuse lepromatous leprosy. The diffuse lesions of Lucio's phenomenon have a predilection for the extremities, can include nodules, and heal with atrophic stellate scars; histologically, a necrotizing vasculitis accompanied by a nonspecific inflammatory reaction may be seen. Because of its rarity and similarity with some manifestations of the rheumatic disease and other causes of vasculitis, Lucio's phenomenon may not be easily recognized, especially in non-endemic countries, which leads to confusing diagnosis and loss of time for treatment. We report five patients with vasculitis caused by Lucio's phenomenon.
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Affiliation(s)
- Pablo Finucci Curi
- Rheumatology Section, Hospital JM Cullen, Av Freyre 2150- (3000), Santa Fe, Argentina
| | - Julieta Solis Villaroel
- Department of Internal Medicine, Hospital Interzonal San Juan Bautista, Catamarca, Argentina
| | - Nora Migliore
- Department of Pathology, Hospital JM Cullen, Santa Fe, Argentina
| | | | | | - Federico Ceccato
- Rheumatology Section, Hospital JM Cullen, Av Freyre 2150- (3000), Santa Fe, Argentina
| | - Sergio Paira
- Rheumatology Section, Hospital JM Cullen, Av Freyre 2150- (3000), Santa Fe, Argentina.
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Kourilovitch M, Galarza-Maldonado C, Ortiz-Prado E. Diagnosis and classification of rheumatoid arthritis. J Autoimmun 2014; 48-49:26-30. [DOI: 10.1016/j.jaut.2014.01.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
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