Hansen’s Disease: An Unusual Manifestation of an Ancient Disease





Arthralgia, Erythema Nodosum, Leprosy, Mycobacterium leprae


Hansen’s disease, commonly known as leprosy, is an infectious disease caused by Mycobacterium leprae. Being rare in developed countries, it is an increasingly common imported disease due to the migratory flow from countries where it is endemic. We present the case of a 21-year-old man who went to the emergency department with complaints of additive polyarthralgia involving large joints, papules, and erythematous plaques on the limbs with bullae and central necrosis and fever with chills for one week. Skin biopsy was performed revealing neutrophilic infiltrate with perineural granulomas. The bacilloscopy detected acid-alcohol resistant bacilli. The diagnosis of multibacillary HD with type 2 lepromatous reaction (erythema nodosum leprosum - ENL) was established, showing clinical improvement under corticosteroid therapy. ENL usually presents with painful lesions, being an atypical presentation of leprosy, especially in the presence of bullae and necrosis, making diagnosis difficult and challenging. Social stigma is often present making it difficult to accept the disease as well as adherence to treatment.


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Organização Mundial da Saúde. Global leprosy update, 2018: moving towards a leprosy-free world. Weekly Epidemiological Record. 2019;94:389-412.

Máquina A, Catarino A, Silva L, Catorze G, Ferreira L, Viana I. Lepra: da antiguidade aos nossos tempos. Port J Derm Venereol. 2019;77:323-38. DOI: https://doi.org/10.29021/spdv.77.4.1116

Scollard D, Stryjewska B, Dacso M. Leprosy: epidemiology, microbiology, clinical manifestations and diagnosis. Up-to-date. 2019. [consultado 2023 dez 01]. Disponível em: www.uptodate.com/contents/leprosy-epidemiology-microbiology-clinical-manifestations-and-diagnosis.

Ramos-e-Silva M, Ribeiro de Castro MC. Mycobacterial infections. In: Bolognia JL, Schaffer JV, Cerroni L, editors. Dermatology. 4ª ed. Amsterdam: Elsevier; 2018. p.1296-303.

Gelbert RH. Leprosy. In: Jameson JL, Kasper DL, Longo DL, Fauci AS, Hauser SL, Loscalzo J, editors. Harrison’s principles of internal medicine. 20ª ed. New York: McGraw Hill Education; 2018. p.1259-66.

Bloom BR, Grosset JH, Lechat MF, Due LK, Nkinda SJ, Rao CK, et al. WHO Expert Committee on Leprosy. World Heal Organ Tech Rep Ser. 2012;768:7-50

Organização Mundial da Saúde. Guidelines for the diagnosis, treatment and prevention of leprosy. Geneve: WHO; 2017.

Ridley DS, Jopling WH. Classification of leprosy according to immunity. A five-group system. Int J Lepr. 1966;34:255-73.

Kamath S, Vaccaro SA, Rea TH, Ochoa MT. Recognizing and managing the immunologic reactions in leprosy. J Am Dermatol. 2014;71:795-803. DOI: https://doi.org/10.1016/j.jaad.2014.03.034



How to Cite

Ferreira M, Grijó C, Paulo J, Fonseca M, Neves Z, Bouceiro Mendes R, Vasconcelos P. Hansen’s Disease: An Unusual Manifestation of an Ancient Disease. Acta Med Port [Internet]. 2024 Jan. 25 [cited 2024 Jul. 25];37(3):215-9. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/20599



Case Report