Video: Knock on Wood| Webinar: ACR/CHEST ILD Guidelines in Practice
fa-facebookfa-linkedinfa-youtube-playfa-rss

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

  • Conditions
    • Axial Spondyloarthritis
    • Gout and Crystalline Arthritis
    • Myositis
    • Osteoarthritis and Bone Disorders
    • Pain Syndromes
    • Pediatric Conditions
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Sjögren’s Disease
    • Systemic Lupus Erythematosus
    • Systemic Sclerosis
    • Vasculitis
    • Other Rheumatic Conditions
  • FocusRheum
    • ANCA-Associated Vasculitis
    • Axial Spondyloarthritis
    • Gout
    • Lupus Nephritis
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  • Guidance
    • Clinical Criteria/Guidelines
    • Ethics
    • Legal Updates
    • Legislation & Advocacy
    • Meeting Reports
      • ACR Convergence
      • Other ACR meetings
      • EULAR/Other
    • Research Rheum
  • Drug Updates
    • Analgesics
    • Biologics/DMARDs
  • Practice Support
    • Billing/Coding
    • EMRs
    • Facility
    • Insurance
    • QA/QI
    • Technology
    • Workforce
  • Opinion
    • Patient Perspective
    • Profiles
    • Rheuminations
      • Video
    • Speak Out Rheum
  • Career
    • ACR ExamRheum
    • Awards
    • Career Development
  • ACR
    • ACR Home
    • ACR Convergence
    • ACR Guidelines
    • Journals
      • ACR Open Rheumatology
      • Arthritis & Rheumatology
      • Arthritis Care & Research
    • From the College
    • Events/CME
    • President’s Perspective
  • Search

Case Report: Leprosy Masquerading as Relapsing Polychondritis

Rohan Goel, MBBS, MD, Rashmi Roongta, MBBS, MD, DM, Dipendranath Ghosh, MBBS, MD, DM, & Parasar Ghosh, MD, DM  |  Issue: September 2024  |  September 9, 2024

Figure 6: Lymph node biopsy shows foamy macrophages interspersed with lymphocytic infiltrates (lepra or Virchow cells).

Autoimmune diseases are characterized by multi-system manifestations, so it is important to rule out chronic infections, such as tuberculosis, leprosy and fungal infections, because the treatments for infections and autoimmune diseases are opposing, with the latter requiring glucocorticoids and immunosuppression and the former requiring antibiotics (and worsening with immunosuppressants). Particularly given the low sensitivity of many diagnostic tests for indolent infections, a high level of suspicion is needed when environmental or occupational histories suggest a higher risk for certain infections.

Our case highlights the importance of looking for chronic infections, such as leprosy, as mimics of AIRDs, such as relapsing polychondritis in this particular scenario.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Complete ear involvement occurs in leprosy in the form of painless, infiltrative nodular lesions of the pinna, with characteristic involvement of the ear lobule because the M. leprae has a predilection for involvement of cooler body sites.3 However, our case presented as painful auricular chondritis, sparing the lobule, which is a characteristic feature of relapsing polychondritis, and leading to the initial incorrect diagnosis.

Tender lymphadenopathy, nerve thickening and skin lesions were oddities in our case, which hinted at leprosy, an age-old mimic of autoimmune disease. The skin biopsy revealed septal panniculitis without vasculitis, with negative Fite-Faraco staining and slit skin smear. Despite that, a high suspicion of leprosy remained. Hence, the tender inguinal lymph node was targeted, which revealed the foamy histiocytes and globi of M. leprae on Fite-Faraco staining, clinching the diagnosis.

Figure 7: Lymph node biopsy Fite-Faraco staining shows globi of M. leprae bacilli. (Click to enlarge.)

Skin biopsy and slit skin smear have a low sensitivity of around 49–70% and 50%, respectively, for a diagnosis of leprosy.4 Gupta et al. did a histopathological study of lymph nodes in 43 cases of leprosy and showed that lymph nodes, if present, can show M. leprae in 92.2% of cases.5 Thus, a clinician should try to get a tissue or microbiological diagnosis, which at times may require repeated attempts at tissue sampling, as in our case.

A thorough history and systemic examination are crucial even in the modern world of advanced diagnostics. Appropriate tissue biopsy should be targeted for definitive diagnosis. One should actively rule out infection before diagnosing an AIRD because the treatments are diametrically opposite.

Page: 1 2 3 4 | Single Page
Share: 

Filed under:Conditions Tagged with:case reportInfectionleprosymimicsrelapsing polychondritis

Related Articles
    A transverse view of the ulnar groove in full elbow extension. The red arrow indicates the advancing edge of the MHTr.

    Recurrent Medial Elbow Pain Following Successful Tommy John Surgery

    August 12, 2020

    A 27-year-old, left-handed man was referred to our ultrasound clinic for left elbow pain. History The patient had been a pitcher on a Minor League Baseball team. Two years before, he developed sudden, severe medial elbow pain while pitching in a game. The pain was associated with some tingling down the left medial forearm. The…

    Using Ultrasound to Diagnose Carpal Tunnel Syndrome

    April 26, 2018

    Note: Updated May 2, 2018, to correct a link in the reference section. The error was introduced in editing. A 44-year-old Caucasian woman presented to the outpatient rheumatology clinic that had followed her for several years for rheumatoid arthritis. She was compliant with her regimen of hydroxychloroquine, etanercept and salsalate. Her chief complaint was worsening…

    The Rheumatologist as Detective

    February 1, 2015

    A case of difficult-to-diagnose Whipple’s disease

    Right: The same view as 2A, with the common peroneal nerve outlined in yellow with a cross-sectional area of 21 mm2.

    Case Report: Ultrasound Reveals Cause of Post-Arthroplasty Knee Pain

    April 15, 2020

    A 65-year-old woman was referred by an orthopedist to a rheumatologist for left knee pain. Previously, in 2014, she underwent left total knee arthroplasty (TKA) for severe osteoarthritis in a different institution. Following the procedure, she experienced severe chronic anterolateral knee pain at rest, exacerbated by walking. Because she was rendered wheelchair bound and required…

  • About Us
  • Meet the Editors
  • Issue Archives
  • Contribute
  • Advertise
  • Contact Us
fa-facebookfa-linkedinfa-youtube-playfa-rss
  • Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1931-3268 (print). ISSN 1931-3209 (online).
  • DEI Statement
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences