The ear, the nerves and the joints: a diagnostic puzzle in newly diagnosed HIV infection: a case report of HIV-associated inflammatory arthropathy mimicking Hansen disease and other infectious rheumatological mimics

Aravind Palraj; Arul Rajamurugan Ponniah Subramanian; Ishwarya Ramadoss; Venkatasubramani Ketheyagowder Veeran

doi:10.18203/2320-6012.ijrms20263131

Authors

Aravind Palraj Institute of Rheumatology, Madras Medical College, Chennai, Tamil Nadu, India https://orcid.org/0009-0003-0175-5683
Arul Rajamurugan Ponniah Subramanian Institute of Rheumatology, Madras Medical College, Chennai, Tamil Nadu, India https://orcid.org/0000-0002-2259-1572
Ishwarya Ramadoss Institute of Rheumatology, Madras Medical College, Chennai, Tamil Nadu, India https://orcid.org/0009-0006-0612-9990
Venkatasubramani Ketheyagowder Veeran Institute of Rheumatology, Madras Medical College, Chennai, Tamil Nadu, India https://orcid.org/0009-0003-8877-0252

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263131

Keywords:

HIV, Inflammatory arthritis, Dactylitis, Hansen disease, Leprosy reaction, Peripheral nerves

Abstract

A 53-year-old man with newly diagnosed HIV-1 infection (CD4+ T-cell count 178 cells/µL) developed a 3-month febrile inflammatory polyarthritis, dactylitis, painful auricular inflammation, nodular and ulcerative skin lesions, hypopigmented macules, and enlargement of bilateral common peroneal and ulnar nerves. Rheumatoid factor, anti-cyclic citrullinated peptide antibody and antinuclear antibody were negative. Slit-skin smears from two sites were negative for acid-fast bacilli (bacteriological index 0); the patient declined skin and lymph-node biopsies. Computed tomography of the chest showed bilateral cavitary consolidation, although sputum acid-fast smears and cartridge-based nucleic acid amplification testing were negative, mycobacterial culture was not performed, and bronchoscopic lavage was non-diagnostic. HIV-associated inflammatory arthropathy remained the working diagnosis. Arthritis and auricular inflammation improved during antiretroviral treatment, empirical antituberculous therapy and a tapering course of prednisolone, but Hansen disease and a lepra reaction could not be confidently excluded.

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