Note from the editor:
since last month we face severe problems with sending out our messages. It seems that LML messages are regarded as SPAM, and as such often blocked. We are trying to find a solution. Bear with us. Pieter AM Schreuder
Leprosy Mailing List – March 1, 2017
Ref.: (LML) Polyarthralgia Syndrome 4 years after starting treatment for HIV of a patient with a history of leprosy
From: Ben Naafs, Munnekesburen, the Netherlands
Referring to the LML letter by Gianfranco Barabino of February 28, 2017: a difficult problem. I cannot give a decisive answer.
Multibacillary patients after treatment have regularly persisters, which even after 20 years under favourable conditions may start growing. Then in most cases the PGL-1 is rising again. Was she really MB?
A tuberculoid relapse with a type I reaction is not so likely, but arthritis with such a reaction is certainly possible. However hypersensitivity is not. Except pain along the nerve and in the area supplied by that nerve, but not a general hypersensitivity. I would more think of HIV with a CD< 200, but I understand she was doing well. Hypersensitivity is well known with HAART including PI’s. But that is not my expertise. I understand that is your idea too.
You may do a biopsy from the sural nerve to make leprosy even less unlikely.
LML - S Deepak, B Naafs, S Noto and P Schreuder
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