ABSTRACT
Leprosy, caused by Mycobacterium leprae, was declared eliminated by
2010. However, new cases continue to arise, often presenting with both
typical and atypical symptoms that can mimic a range of skin diseases,
inflammatory arthritis, and autoimmune disorders. We present the case of
a 67-year-old male presenting with symmetrical polyarthralgia in his
hands, accompanied by tingling, and later decreased sensation along the
ulnar aspect of his left hand, along with frequent ulcerated lesions. He
was initially treated with oral Methotrexate for seronegative rheumatoid
arthritis. Due to the persistence of symptoms, he was noncompliant with
methotrexate. Upon further evaluation, we noted ulnar clawing and
diminished to absent sensation in the ulnar distribution, palpable ulnar
nerve, and leonine like facies. A slit skin smear test confirmed the
diagnosis of leprosy, which was positive. Clinical improvements were
visible with the initiation of MDT and oral steroids. Clinicians must
maintain a high index of suspicion for this disease, particularly in
patients hailing from endemic leprosy regions.Keywords: Leprosy, Mycobacterium, Rheumatoid Arthritis, ulnar
clawing, MDT