(LML) Polyarthralgia Syndrome 4 years after starting treatment for HIV of a patient with a history of leprosy

 

 

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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

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Dear Pieter,

 

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.

With regards,

Ben Naafs

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

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