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A 42-year-old man developed progressive numbness, swelling, and pain in the extremities, followed by persistent bilateral knee pain and later facial, truncal, and limb rash. Early rheumatologic workup showed HLA-B27 positivity without typical inflammatory or autoimmune markers, and anti-inflammatory treatment failed. Definitive skin findings and acid-fast bacilli supported leprosy, highlighting the need to consider leprosy in refractory arthritis or neuropathy even outside endemic areas.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hla-b27-positive-leprosy-masquerading-as-peripheral-spondyloarthritis-a-case-report/407105/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hla-b27-positive-leprosy-masquerading-as-peripheral-spondyloarthritis-a-case-report/407105.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why can HLA-B27-positive leprosy be misdiagnosed as peripheral spondyloarthritis?","Question",{"text":112,"@type":113},"Because musculoskeletal manifestations may dominate early, while typical skin findings can appear late or be absent. HLA-B27 positivity can further mimic peripheral spondyloarthritis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What symptoms did the patient initially experience before the correct diagnosis?",{"text":117,"@type":113},"He developed progressive numbness, swelling, and pain in the extremities, later with persistent bilateral knee pain and mild activity limitation.",{"name":119,"@type":110,"acceptedAnswer":120},"What evidence supported the diagnosis of lepromatous leprosy?",{"text":121,"@type":113},"Skin examination showed leonine facies and multiple infiltrated erythematous lesions, and smears from multiple skin sites demonstrated high-grade acid-fast bacilli positivity.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},407105,1790740991,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Case Reports in Dermatology  \n\n| Case Rep Dermatol 2026;18:11–17 |  |\n| --- | --- |\n| DOI: 10. 1159/000549460\u003Cbr>Received: August 8, 2025\u003Cbr>Accepted: November 3, 2025\u003Cbr>Published online: November 29, 2025 | © 2025 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/cde](www.karger.com/cde) |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nSingle Case  \nHLA-B27-Positive Leprosy Masquerading as Peripheral Spondyloarthritis: A Case Report  \nQian Peng Afang Xu Qijing Xiao Xiaobing Wang  \nDermatology Hospital of Jiangxi Province, Jiangxi Provincial Clinical Research Center For Skin Diseases, Candidate Branch of National Clinical Research Center for Skin Diseases, JXHC Key Laboratory of Skin Infection and Immunity, The Affiliated Dermatology Hospital of Nanchang University, Nanchang, China  \nKeywords  \nLeprosy · Lepromatous leprosy · Arthritis · Peripheral spondyloarthritis · HLA-B27  \nAbstract  \nIntroduction: Leprosy, caused by Mycobacterium leprae, is primarily characterized by cutaneous and peripheral nerve involvement. Nonetheless, musculoskeletal manifestations are also frequently observed and are commonly misdiagnosed as rheumatic diseases. Case Presentation: We report a case of lepromatous leprosy presenting with chronic arthritis and HLA-B27 positivity, which was misdiagnosed as peripheral spondyloarthritis in the early stage due to the absence of typical clinical manifestations. Conclusion: Lepromatous leprosy may mimic peripheral spondyloarthritis, especially with HLA-B27 positivity. Clinicians should consider leprosy in refractory arthritis or neuropathy, even in non-endemic areas, to prevent disability and transmission.  \n© 2025 The Author(s) .  \nPublished by S. KargerAG, Basel  \nIntroduction  \nLeprosy is a chronic infectious disease predominantly characterized by skin and peripheral nerve involvement. However, musculoskeletal manifestations are also frequently observed and can closely resemble rheumatic conditions [1] . Diagnosis becomes particularly challenging when skin lesions emerge late or are absent, and symptoms are confined to neurological and musculoskeletal complaints, increasing the risk of misdiagnosis or missed diagnosis. We present a case of lepromatous leprosy (LL) initially treated as peripheral  \nCorrespondence to:  \nXiaobing Wang, wangxiaobing202208  [163.com](163.com)  \nCase Reports in Dermatology  \nCase Rep Dermatol 2026;18:11–17 12  \n\n| DOI: 10. 1159/000549460 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cde](www.karger.com/cde) |\n| --- | --- |\n\nPeng et al.: HLA-B27-Positive Leprosy Masquerading as Peripheral Spondyloarthritis  \nspondyloarthritis (pSpA) for an extended period. The CARE Checklist has been completed by the authors for this case report, attached as online supplementary material (for all online suppl. material, see [https://doi.org/10.1159/000549460](https://doi.org/10.1159/000549460)).  \nCase Presentation  \nA 42-year-old male, originally from Fuzhou, Jiangxi province, and residing in Nanchang, Jiangxi for over a decade, presented with progressive numbness, swelling, and pain in the extremities for 2 years, and rash on the face, trunk, and limbs for 4 months. Approximately 2 years prior, the patient developed insidious numbness in his right big toe. The numbness progressively intensified, extended proximally, and eventually involved the contralateral side and both forearms. Subsequently, he developed persistent bilateral knee pain with mild activity limitation. Pain did not significantly improve with rest, and morning stiffness was denied. Edema developed in the distal extremities. The patient reported no known contact with individuals affected by leprosy. During this period, he sought care multiple t","cbCaijYSHoIplQao","https://ap.wps.com/l/cbCaijYSHoIplQao","pdf",2528427,"English","# Introduction\n## Case Presentation\n## Conclusion","[{\"question\":\"Why can HLA-B27-positive leprosy be misdiagnosed as peripheral spondyloarthritis?\",\"answer\":\"Because musculoskeletal manifestations may dominate early, while typical skin findings can appear late or be absent. HLA-B27 positivity can further mimic peripheral spondyloarthritis.\"},{\"question\":\"What symptoms did the patient initially experience before the correct diagnosis?\",\"answer\":\"He developed progressive numbness, swelling, and pain in the extremities, later with persistent bilateral knee pain and mild activity limitation.\"},{\"question\":\"What evidence supported the diagnosis of lepromatous leprosy?\",\"answer\":\"Skin examination showed leonine facies and multiple infiltrated erythematous lesions, and smears from multiple skin sites demonstrated high-grade acid-fast bacilli positivity.\"}]","HLA-B27-Positive Leprosy Masquerading as Peripheral Spondyloarthritis - A Case Report | PDF",1790570350,18]