Post-MDTL Arthritis in Lepromatous Leprosy: A Case Report of Erosive Joint Disease

Abstract

The musculoskeletal complications of Hansen's disease frequently mimic autoimmune rheumatic conditions and may emerge or persist despite the completion of antimicrobial regimens. This case report outlines the therapeutic assessment of an 18-year-old male diagnosed with lepromatous leprosy (LL) who developed progressive inflammatory polyarthritis affecting the proximal phalanges. Following a 12-month course of Multi-Drug Therapy for Leprosy (MDTL), the patient achieved Release from Treatment (RFT) status, with post-treatment slit-skin smear evaluation demonstrating a Morphological Index (MI) of 0—confirming eradication of viable Mycobacterium leprae—despite a persistently positive Bacteriological Index (BI) of 1.3+ reflecting residual non-viable bacillary antigens. Despite this confirmed bacteriological response, the articular inflammation persisted, necessitating targeted pharmacological management. This report emphasizes the critical need for diagnostic vigilance within endemic regions and advocates for integrated treatment pathways that combine antimicrobial agents with Disease-Modifying Antirheumatic Drugs (DMARDs) to avert irreversible structural deformities.