Seronegative Bilateral Symmetrical Inflammatory Polyarthritis: Think Twice Before Starting Immunosuppression
  • Omar Alsaed
    Department of Medicine (Rheumatology), Hamad Medical Corporation, Doha, Qatar
  • Nawal Hadwan
    Department of Medicine (Rheumatology), Hamad Medical Corporation, Doha, Qatar
  • Izzat Khanjar
    Department of Medicine (Rheumatology), Hamad Medical Corporation, Doha, Qatar
  • Abdul-Wahab Al-Allaf
    Hamad General Hospital/ Hamad Medical Institute

Keywords

Seronegative rheumatoid arthritis, leprosy

Abstract

The most common cause of bilateral symmetrical polyarthritis in the small joints is rheumatoid arthritis. However, if seronegative arthritis is involved, it could be the case that other underlying causes need to be diagnosed. This is particularly important for those coming from or living in developing countries where infectious causes should always be considered. The case of a young Nepali woman is presented in this article. She was referred as a case of seronegative rheumatoid arthritis for DMARDs therapy but this was not the case due to her origin from Nepal and seronegativity for RF, Anti-ccp, and ANA as well as faint macular skin lesions over her face and upper extremities, which the patients are not aware of. Consequently, skin biopsy was carried out which subsequently confirmed that the infectious cause of her polyarthritis was leprosy.

VIEW THE ENTIRE ARTICLE

References

  • Global leprosy situation, 2010. Wkly Epidemiol Rec 2010;85:337.

  • Abraham S, Mozhi NM, Joseph GA, et al. Epidemiological significance of first skin lesion in leprosy. Int J Lepr Other Mycobact Dis 1998;66:131.

  • Bonvoisin B, Martin JM, Bouvier M, Bocquet B, Boulliat J, Duivon JP. Articular manifestations of leprosy. Sem Hop 1983;59:302–5.

  • Atkin SL, el-Ghobarey A, Kamel M, Owen JP, Dick WC. Clinical and laboratory studies of arthritis in leprosy. Br Med J 1989;298:1423–5.

  • Albert DA, Weisman MH, Kaplan R. The rheumatic manifestations of leprosy [Hansen disease]. Medicine 1980;59:442–8.

  • Lele RD, Sainani GS, Sharma KD et al. Leprosy presenting as rheumatoid arthritis. J Assoc Physicians India 1965;13:275–7.

  • Cossermelli-Messina W, Festa Neto C, Cossermelli W. Articular inflammatory manifestations in patients with different forms of leprosy. J Rheumatol 1998;25:111–9.

  • Gibson T, Ahsan Q, Hussein K. Arthritis of leprosy. Br J Rheumatol 1994;33:963–6.

  • Alcocer J, Herrera R, Lavelle C, Guidino J, Fraga A. Inflammatory arthropathy in leprosy. Arthritis Rheum 1979;22:587.

  • Lele RD, Sainani GS, Sharma KD et al. Leprosy presenting as rheumatoid arthritis. J Assoc Physicians India 1965;13:275–7.

  • Modi TH, Lele RD. Acute joint manifestations of leprosy. J Assoc Physicians India 1969;17:247–54.

  • Scollard DM. Time and change: new dimensions in the immunopathologic spectrum of leprosy. Ann Soc Belg Med Trop 1993;73 Suppl 1:5.

  • Rath D, Bhargava S, Kundu BK. Leprosy mimicking common rheumatologic entities: a trial for the clinician in the era of biologics. Case Rep Rheumatol 2014;429698.

    • Views: 1701
    HTML downloads: 262
    PDF downloads: 549

    Published: 2018-06-04
    Issue: Vol 5 No 8 (view)

    How to cite:
    1.
    Alsaed O, Hadwan N, Khanjar I, Al-Allaf A-W. Seronegative Bilateral Symmetrical Inflammatory Polyarthritis: Think Twice Before Starting Immunosuppression. EJCRIM 2018;5 doi:10.12890/2018_000895.