Non Radiographic Axial Spondyloarthropathy in Tuberculoid Leprosy

Rationale: Axial Spondyloarthirtis (ax-SpA) includes a non-radiographic variant, called Non Radiographic Axial Spondyloararthrophy (nr-ax-SpA), which is a very rare type of arthritis of spine. Hansen disease or Leprosy is a chronic infectious disease with various clinical manifestations, which is endemic in India. Various arthritic manifestations have been reported in leprosy patients. Though the condition is treatable and reversible, it may remain unrecognized and undisclosed in patients suffering with Leprosy. Patient concern: Here we illustrate a case of non-radiographic axial spondyloararthrophy in 40-year old male with diagnosis of borderline Hansen’s disease (leprosy) 15 years ago. Patient had reported chronic back pain for over five years, leading to stiffness of dorsal spine, and presented swollen wrist joint. Leprosy symptoms presented include dry hyper-pigmented, non-ulcerating, hypo-aesthetic (pain and temperature) patches on both legs, buttocks, upper abdomen and iliac crest. Diagnosis: The patient was diagnosed as border line tuberculoid leprosy with nr-ax-SpA. Treatments: He was treated with in domethacin, leflunomide and hydroxy-chloroquine, along with a standard treatment regimen to combat BT Leprosy. Follow up at 3 and 6 month revealed significant improvement. Keywords: spondyloarthritis; leprosy; hydroxy-chloroquine.