Skip to main content
NCBI home page
British Medical Journal logoLink to British Medical Journal
. 1975 Sep 13;3(5984):619–621. doi: 10.1136/bmj.3.5984.619

Lepromatous leprosy presenting with polyarthritis, myositis, and immune-complex glomerulonephritis.

J M Iveson, A C McDougall, A J Leathem, H J Harris
PMCID: PMC1674437  PMID: 126102

Abstract

A Pakistani man aged 19 years was admitted to a rheumatological unit in the United Kingdom with acute widespread polyarthritis accompanied by night sweats and fever. Preliminary examination suggested Reiter's disease, but further investigation showed acute glomerulonephritis with uraemia. The possibility of periarteritis nodosa, and the prominence of muscle tenderness in the legs, led to biopsies of striated muscle and skin, in both of which were changes typical of lepromatous leprosy, with many Mycobacterium leprae on Ziehl-Neelsen staining. Serum showed IgG-IgM cryoglobulinaemia without antiglobulin activity, and in the recovery phase renal biopsy showed a resolving proliferative glomerulonephritis with linear IgG and IgM immunofluorescence and granular deposits of C3. Clinical signs subsided rapidly under steroid treatment and subsequent progress on anti-leprosy drugs was uneventful. The term erythema nodosum leprosum is inadequate and misleading as a title for a common and important immune-complex reaction of lepromatous leprosy, in which numerous body systems may be involved.

Full text

PDF
619

Images in this article

620FIG. 1
on p.620
620FIG. 2
on p.620
620FIG. 3
on p.620

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BRUSCO C. M., MASANTI J. G. CAUSES OF DEATH OF LEPROSY PATIENTS, INFLUENCE OF LEPRA REACTIONS AND RENAL DISEASE. Int J Lepr. 1963 Jan-Mar;31:14–25. [PubMed] [Google Scholar]
  2. Bonomo L., Dammacco F. Immune complex cryoglobulinaemia in lepromatous leprosy: a pathogenetic approach to some clinical features of leprosy. Clin Exp Immunol. 1971 Aug;9(2):175–181. [PMC free article] [PubMed] [Google Scholar]
  3. Bullock W. E., Callerame M. L., Panner B. J. Immunohistologic alteration of skin and ultrastructural changes of glomerular basement membranes in leprosy. Am J Trop Med Hyg. 1974 Jan;23(1):81–86. doi: 10.4269/ajtmh.1974.23.81. [DOI] [PubMed] [Google Scholar]
  4. Desikan K. V., Job C. K. A review of postmortem findings in 37 cases of leprosy. Int J Lepr Other Mycobact Dis. 1968 Jan-Mar;36(1):32–44. [PubMed] [Google Scholar]
  5. Drutz D. J., Gutman R. A. Renal manifestations of leprosy: glomerulonephritis, a complication of erythema nodosum leprosum. Am J Trop Med Hyg. 1973 Jul;22(4):496–502. doi: 10.4269/ajtmh.1973.22.496. [DOI] [PubMed] [Google Scholar]
  6. Jopling W. H., Mehta H. D. A case of leprous nodular interstitial myositis. Lepr Rev. 1972 Mar;43(1):39–43. doi: 10.5935/0305-7518.19720007. [DOI] [PubMed] [Google Scholar]
  7. Jopling W. H. Reactions in leprosy. Lepr Rev. 1970 Jan;41(1):62–63. [PubMed] [Google Scholar]
  8. Karat A. B., Karat S., Job C. K., Furness M. A. Acute exudative arthritis in leprosy--rheumatoid-arthritis-like syndrome in association with erythema nodosum leprosum. Br Med J. 1967 Sep 23;3(5568):770–772. doi: 10.1136/bmj.3.5568.770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lancet M. [Editorial: News in methods of family planning]. Harefuah. 1974 Jun 2;86(11):570–572. [PubMed] [Google Scholar]
  10. Manigand G., Paillas J., Lardy B., Deparis M. La polyarthrite de la lèpre. A propos d'une observation de polyarthrite diffuse, symétrique et fébrile révélatrice d'une lèpre lépromateuse jusqu'alors méconnue. Sem Hop. 1969 Feb 14;45(8):543–552. [PubMed] [Google Scholar]
  11. Wemambu S. N., Turk J. L., Waters M. F., Rees R. J. Erythema nodosum leprosum: a clinical manifestation of the arthus phenomenon. Lancet. 1969 Nov 1;2(7627):933–935. doi: 10.1016/s0140-6736(69)90592-3. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES