Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report

• Main Authors: Miguel Gomes Guerra, Taciana Marta Ferreira Cardoso Videira, Hugo Alexandre Gomes Morais, Telma Cristiana Resse Nunes Santos, Ricardo Jorge Ferreira Taipa, Miguel Araújo Abreu, Romana Carisa Carvalho Vieira, Diogo Miranda Gonçalves Guimarães da Fonseca, Joana Patrícia Abelha Aleixo dos Santos, Sandra Patrícia Abreu Monteiro Pinto
• Format: Article
• Language: English
• Published: BMC 2019-05-01
• Series: BMC Infectious Diseases
• Subjects: Leprosy; Remitting seronegative symmetrical synovitis with pitting Oedema syndrome; Peripheral neuropathy
• Online Access: http://link.springer.com/article/10.1186/s12879-019-4098-9

Abstract Background Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. Case report A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. Conclusion This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.