Lepromatous leprosy mimicking systemic lupus erithematosus: a case report

  • Niken Kusumaningrum Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta
  • Schandra Purnamawati Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta; aculty of Medicine, Universitas Jenderal Soedirman, Purwokerto
  • Dwi Retno Adi Winarni Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta
  • Hardyanto Soebono Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta
Keywords: lepromatous leprosy, systemic lupus erythematosus
Abstract viewed: 1746 times
PDF downloaded: 1072 times
HTML downloaded: 304 times
EPUB downloaded: 196 times

Abstract

The clinical manifestations of leprosy are highly variable, and the disease is notorious for being “a great imitator” of several other conditions. Leprosy may manifest with a variety of phenomena resembling those of autoimmune diseases. Herein, we report a 33-year-old male presenting with wounds on his left leg and hyperpigmented skin lesions all over his body. Six years earlier, the patient was diagnosed with systemic lupus erythematosus (SLE). However, therapy for SLE did not control his symptoms; instead, the patient developed features of leprosy, such as anesthetic skin lesions, nerve enlargement, and tenderness. Tests for antinuclear antibodies and anti-double stranded DNA antibodies were negative. Slit-skin smear showed a bacterial index of 6+ and morphological index of 10 %. Lupus band test results were negative. Histological findings were compatible with lepromatous leprosy. The clinical and serological similarities between leprosy and SLE may lead to erroneous diagnosis. Thus, clinicians should be aware of this characteristic for correct diagnosis.

References

  1. Horta-Baas G, Hernández-Cabrera MF, Barile-Fabris LA, Romero- Figueroa Mdel S, Arenas-Guzmán R. Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review. Lupus. 2015;24(10):1095–102. https://doi.org/10.1177/0961203315574557

  2. Hsieh TT, Wu YH. Leprosy mimicking lupus erythematosus. Dermatol Sin. 2014;32(1):47–50.https://doi.org/10.1016/j.dsi.2013.01.004

  3. Lopes VA, Lourenço DM, Guariento A, Trindade MA, Avancini J, Silva CA. Borderline tuberculoid leprosy in childhood onset systemic lupus erythematosus patient. Lupus. 2015;24(13):1448–51. https://doi.org/10.1177/0961203315593167

  4. Damodar SS, Smitha P, Nirmal B, Sudhir NU, Ballambat PS. Hansen's disease associated with erythromelalgia mimicking lupus erythematosus. Indian Dermatol Online J. 2014;5(1):59â62. https://doi.org/10.4103/2229-5178.126035

  5. Alberti JR, Cabrera A, Martiniuk F, Sanchez M, Levis WR. Leprosy masquerading as lupus. J Am Acad Dermatol. 2005;52(4):702–3. https://doi.org/10.1016/j.jaad.2004.09.025

  6. Hattori M, Motegi S, Amano H, Ishii N, Ishikawa O. Borderline lepromatous leprosy: cutaneous manifestation and type 1 reversal reaction. Acta Derm Venereol. 2016;96(3):422–3. https://doi.org/10.2340/00015555-2251

  7. Ribeiro FM, Gomez VE, Albuquerque EM,Klumb EM, Shoenfeld Y. Lupus and leprosy: beyond the coincidence. Immunol Res. 2015;61(1â2):160–3. https://doi.org/10.1007/s12026-014-8596-y

  8. Trindade MA, Valente NY, Manini MI, Takahashi MD, Anjos CF, Benard G, et al. Two patients coinfected with Mycobacterium leprae and human immunodeficiency virus type 1 and naïve for antiretroviral therapy who exhibited type 1 leprosy reactions mimicking the immune reconstitution inflammatory syndrome. J Clin Microbiol. 2006;44(12):4616–8. https://doi.org/10.1128/JCM.01425-06

  9. Karadeniz A, Lally L, Magro C, Levy R, Erkan D, Lockshin MD. Lepromatous leprosy mimicking systemic lupus erythematosus. HSS J. 2014;10(3):286–91. https://doi.org/10.1007/s11420-014-9405-9

  10. Pratap DV, Reddy SK, Rani SC, Krishna VA, Indira D. ANA-negative systemic lupus erythematosus. Indian J Dermatol Venereol Leprol. 2004;70(4):243–4. https://doi.org/10.1155/2016/4507247

Published
2019-05-08
How to Cite
1.
Kusumaningrum N, Purnamawati S, Winarni DRA, Soebono H. Lepromatous leprosy mimicking systemic lupus erithematosus: a case report. Med J Indones [Internet]. 2019May8 [cited 2024Apr.20];28(1):77-1. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1793
Section
Case Report/Series