Lepromatous Leprosy Mimicking Systemic Lupus Erythematosus
Year: 2014
Type: article
Study design: Case Report
Abstract: A 29-year-old Brazilian woman was referred for management of systemic lupus erythematosus (SLE) with antiphospholipid antibodies (aPL).Her symptoms were 1 year of intermittent fever and diffuse, tender, erythematosus, and nodular rash that began during her first pregnancy.She was treated with short course of lowdose corticosteroids, with resolution; however, she suffered an embryonic loss at 7 weeks.Six months prior to admission, she had recurrence of the nodular rash with new onset arthralgia; a skin biopsy showed panniculitis.Tests done at that time showed lupus anticoagulant (LA), anticardiolipin antibody (aCL) IgM >150 U (normal 0-7 U), anti-β 2 glycoprotein-I (aβ 2 GPI) IgM >150 U (normal <10 U), and aβ 2 GPI IgA of 135 U/ mL (normal <10 U), the other isotypes being negative.For the presumed diagnosis of a "systemic lupus erythematous (SLE)-like autoimmune disease," she was prescribed hydroxychloroquine (HCQ) 300 mg daily and prednisone 10 mg twice a day with significant response.However, her nodules recurred in 1 month when her prednisone dose was tapered to 15 mg daily, and azathioprine 100 mg daily and dapsone 25 mg daily were begun.Four months prior to admission, her rash and fever worsened.Prednisone was increased to 60 mg a day with no improvement.Three months prior to admission, she developed symmetric polyarthritis of metacarpophalangeal joints (MCPs), proximal interphalangeal joints (PIPs), wrists, knees, and ankles.Prednisone was increased to 120 mg daily and her azathioprine was switched to mycophenolate mofetil (MMF) 3.0 g daily with improvement.Two months prior to admission, she was started on enoxaparin sodium subcutaneously 50 mg twice daily.One month prior to admission, MMF was stopped and dapsone dose was increased to 50 mg daily.Despite the above management, her condition worsened.When she was admitted, she had diffuse erythematous papules and nodules over her extremities, abdomen, chest, back, and face.She denied weight loss, night sweats, alopecia, photosensitivity, oral ulcers, sicca symptoms, Raynaud's phenomenon, chest pain, shortness of breath, cough, nausea and vomiting, abdominal pain, dysuria, hematuria, arthritis, arthralgia, and myalgia.She had no history of thrombosis.She had no recent travel history and had emigrated from
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2314740889