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