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

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 S...

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Autores principales: Guerra, Miguel Gomes, Videira, Taciana Marta Ferreira Cardoso, Morais, Hugo Alexandre Gomes, Santos, Telma Cristiana Resse Nunes, Taipa, Ricardo Jorge Ferreira, Abreu, Miguel Araújo, Vieira, Romana Carisa Carvalho, da Fonseca, Diogo Miranda Gonçalves Guimarães, dos Santos, Joana Patrícia Abelha Aleixo, Pinto, Sandra Patrícia Abreu Monteiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530132/
https://www.ncbi.nlm.nih.gov/pubmed/31117984
http://dx.doi.org/10.1186/s12879-019-4098-9
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author Guerra, Miguel Gomes
Videira, Taciana Marta Ferreira Cardoso
Morais, Hugo Alexandre Gomes
Santos, Telma Cristiana Resse Nunes
Taipa, Ricardo Jorge Ferreira
Abreu, Miguel Araújo
Vieira, Romana Carisa Carvalho
da Fonseca, Diogo Miranda Gonçalves Guimarães
dos Santos, Joana Patrícia Abelha Aleixo
Pinto, Sandra Patrícia Abreu Monteiro
author_facet Guerra, Miguel Gomes
Videira, Taciana Marta Ferreira Cardoso
Morais, Hugo Alexandre Gomes
Santos, Telma Cristiana Resse Nunes
Taipa, Ricardo Jorge Ferreira
Abreu, Miguel Araújo
Vieira, Romana Carisa Carvalho
da Fonseca, Diogo Miranda Gonçalves Guimarães
dos Santos, Joana Patrícia Abelha Aleixo
Pinto, Sandra Patrícia Abreu Monteiro
author_sort Guerra, Miguel Gomes
collection PubMed
description 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.
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spelling pubmed-65301322019-05-28 Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report Guerra, Miguel Gomes Videira, Taciana Marta Ferreira Cardoso Morais, Hugo Alexandre Gomes Santos, Telma Cristiana Resse Nunes Taipa, Ricardo Jorge Ferreira Abreu, Miguel Araújo Vieira, Romana Carisa Carvalho da Fonseca, Diogo Miranda Gonçalves Guimarães dos Santos, Joana Patrícia Abelha Aleixo Pinto, Sandra Patrícia Abreu Monteiro BMC Infect Dis Case Report 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. BioMed Central 2019-05-22 /pmc/articles/PMC6530132/ /pubmed/31117984 http://dx.doi.org/10.1186/s12879-019-4098-9 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Guerra, Miguel Gomes
Videira, Taciana Marta Ferreira Cardoso
Morais, Hugo Alexandre Gomes
Santos, Telma Cristiana Resse Nunes
Taipa, Ricardo Jorge Ferreira
Abreu, Miguel Araújo
Vieira, Romana Carisa Carvalho
da Fonseca, Diogo Miranda Gonçalves Guimarães
dos Santos, Joana Patrícia Abelha Aleixo
Pinto, Sandra Patrícia Abreu Monteiro
Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
title Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
title_full Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
title_fullStr Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
title_full_unstemmed Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
title_short Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
title_sort leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome – a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530132/
https://www.ncbi.nlm.nih.gov/pubmed/31117984
http://dx.doi.org/10.1186/s12879-019-4098-9
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