{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:21:43Z","timestamp":1788182503503,"version":"build-2803163510"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":73,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Leprosy can mimic systemic lupus erythematosus (SLE) due to overlapping clinical, laboratory, and immunological features, frequently resulting in misdiagnosis and inappropriate immunosuppressive treatment. We report a case of leprosy initially misdiagnosed as SLE and systematically review the literature on leprosy cases mimicking SLE, emphasizing clinical, laboratory, therapeutic, and outcome characteristics, evaluated in light of the 2019 ACR\/EULAR classification criteria for SLE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted according to PRISMA guidelines. PubMed, SciELO, and Google Scholar were searched for articles published up to August 2025. Case reports and case series describing leprosy previously diagnosed as SLE were included. The protocol was prospectively registered in PROSPERO (CRD420261283210).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-three patients, including the index case, were analyzed. Most were female (78.2%), with a median age of 35 years (interquartile range [IQR] 30\u201347.5). Cutaneous manifestations were present in all patients, particularly malar rash (43.4%), photosensitivity (34.7%), and cutaneous nodules (30.4%). Osteoarticular involvement occurred in 78.2% and neurological manifestations in 43.4%. Antinuclear antibodies were positive in 74% of cases, frequently at low to moderate titers. Lepromatous leprosy was the most frequent form (69.5%). Prior to the correct diagnosis, 65.2% of patients fulfilled the EULAR\/ACR classification criteria for SLE, 87% received corticosteroids and 69.5% antimalarials. Diagnostic delay exceeded one year in nearly half of cases. After initiation of multidrug therapy, 47% of patients showed clinical improvement, although leprosy reactions and residual symptoms remained common (35.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Leprosy should be considered in the differential diagnosis of SLE, particularly in patients presenting with cutaneous and articular manifestations accompanied by peripheral neuropathy and poor response to immunosuppressive therapy. By delineating recurring clinical patterns and diagnostic pitfalls, our findings provide practical clues for earlier recognition, helping to prevent diagnostic delay, inappropriate immunosuppression, and adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42358-026-00548-w","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:05:03Z","timestamp":1781863503000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Leprosy masquerading as systemic lupus erythematosus: a case report and systematic review of the literature"],"prefix":"10.1186","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3744-3273","authenticated-orcid":false,"given":"Miguel Marcelo Freire","family":"de Melo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7857-9168","authenticated-orcid":false,"given":"Lara Ponte","family":"Amadei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0278-5270","authenticated-orcid":false,"given":"Jo\u00e3o Macedo Coelho","family":"Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4475-6064","authenticated-orcid":false,"given":"Rejane Maria Rodrigues","family":"de Abreu Vieira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3337-1707","authenticated-orcid":false,"given":"Niedja Bezerra","family":"Frota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1bio","family":"T\u00e1vora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9047-4637","authenticated-orcid":false,"given":"Lysiane Maria Adeodato","family":"Ramos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1367-6782","authenticated-orcid":false,"given":"Carlos Ewerton Maia","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"548_CR1","unstructured":"Minist\u00e9rio da Sa\u00fade (BR). Protocolo cl\u00ednico e diretrizes terap\u00eauticas da hansen\u00edase. Bras\u00edlia (DF): Minist\u00e9rio da Sa\u00fade. 2023. https:\/\/www.gov.br\/saude\/pt-br\/assuntos\/saude-de-a-a-z\/h\/hanseniase\/publicacoes\/protocolo-clinico-e-diretrizes-terapeuticas-da-hanseniase-2022\/view"},{"key":"548_CR2","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1590\/S0482-50042009000500006","volume":"49","author":"SLE Ribeiro","year":"2009","unstructured":"Ribeiro SLE, Pereira HLA, Silva NP, Sato EI. Autoanticorpos em pacientes com hansen\u00edase, com e sem comprometimento articular, no Estado do Amazonas. Rev Bras Reumatol. 2009;49:547\u201361. https:\/\/doi.org\/10.1590\/S0482-50042009000500006.","journal-title":"Rev Bras Reumatol"},{"key":"548_CR3","doi-asserted-by":"publisher","first-page":"1239775","DOI":"10.3389\/fmed.2023.1239775","volume":"10","author":"VA Cruz","year":"2003","unstructured":"Cruz VA, Albuquerque CP, Guimar\u00e3es MFBR, et al. New insights at the interface between leprosy and immune-mediated rheumatic diseases. Front Med (Lausanne). 2003;10:1239775. https:\/\/doi.org\/10.3389\/fmed.2023.1239775.","journal-title":"Front Med (Lausanne)"},{"key":"548_CR4","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1177\/0961203315574557","volume":"24","author":"G Horta-Baas","year":"2015","unstructured":"Horta-Baas G, Hern\u00e1ndez-Cabrera MF, Barile-Fabris LA, et al. Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review. Lupus. 2015;24:1095\u2013102. https:\/\/doi.org\/10.1177\/0961203315574557.","journal-title":"Lupus"},{"key":"548_CR5","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1007\/s12026-014-8596-y","volume":"61","author":"FM Ribeiro","year":"2015","unstructured":"Ribeiro FM, Gomez VE, Albuquerque EMN, et al. Lupus and leprosy: beyond the coincidence. Immunol Res. 2015;61:160\u20133. https:\/\/doi.org\/10.1007\/s12026-014-8596-y.","journal-title":"Immunol Res"},{"key":"548_CR6","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1002\/art.40930","volume":"71","author":"M Aringer","year":"2019","unstructured":"Aringer M, Costenbader K, Daikh D, et al. 2019 EULAR\/ACR classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019;71:1400\u201312. https:\/\/doi.org\/10.1002\/art.40930.","journal-title":"Arthritis Rheumatol"},{"key":"548_CR7","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https:\/\/doi.org\/10.1136\/bmj.n71.","journal-title":"BMJ"},{"key":"548_CR8","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.clindermatol.2005.01.012","volume":"23","author":"M Ramos-e-Silva","year":"2005","unstructured":"Ramos-e-Silva M, Oliveira ML, Munhoz-da-Fontoura GH. Leprosy: uncommon presentations. Clin Dermatol. 2005;23:509\u201314. https:\/\/doi.org\/10.1016\/j.clindermatol.2005.01.012.","journal-title":"Clin Dermatol"},{"key":"548_CR9","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/j.jaad.2004.09.025","volume":"52","author":"JR Alberti","year":"2005","unstructured":"Alberti JR, Cabrera A, Martiniuk F, Sanchez M, Levis WR. Leprosy masquerading as lupus. J Am Acad Dermatol. 2005;52:702\u20133. https:\/\/doi.org\/10.1016\/j.jaad.2004.09.025.","journal-title":"J Am Acad Dermatol"},{"key":"548_CR10","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/RHU.0b013e318064e7a0","volume":"13","author":"C Flower","year":"2007","unstructured":"Flower C, Gaskin D, Marquez S. A case of recurrent rash and leg numbness mimicking systemic rheumatic disease: the occurrence of leprosy in a nonendemic area. J Clin Rheumatol. 2007;13:143\u20135. https:\/\/doi.org\/10.1097\/RHU.0b013e318064e7a0.","journal-title":"J Clin Rheumatol"},{"key":"548_CR11","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1590\/S1413-86702009000200017","volume":"13","author":"MA Trindade","year":"2009","unstructured":"Trindade MA, Varella TC, Cisneros CG, Bottini V, Moura AK. Delayed diagnosis of multibacillary leprosy: a report of eight cases. Braz J Infect Dis. 2009;13:155\u20137. https:\/\/doi.org\/10.1590\/S1413-86702009000200017.","journal-title":"Braz J Infect Dis"},{"key":"548_CR12","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1111\/j.1440-0960.2008.00499.x","volume":"50","author":"R Manifold","year":"2009","unstructured":"Manifold R, Marshman G. Leprosy: not always an easy diagnosis and often a management challenge. Australas J Dermatol. 2009;50:36\u201340. https:\/\/doi.org\/10.1111\/j.1440-0960.2008.00499.x.","journal-title":"Australas J Dermatol"},{"key":"548_CR13","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.dsi.2013.01.004","volume":"32","author":"TT Hsieh","year":"2014","unstructured":"Hsieh TT, Wu YH. Leprosy mimicking lupus erythematosus. Dermatol Sin. 2014;32:47\u201350. https:\/\/doi.org\/10.1016\/j.dsi.2013.01.004.","journal-title":"Dermatol Sin"},{"key":"548_CR14","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s11420-014-9405-9","volume":"10","author":"A Karadeniz","year":"2014","unstructured":"Karadeniz A, Lally L, Magro C, Levy R, Erkan D, Lockshin MD. Lepromatous leprosy mimicking systemic lupus erythematosus: a clinical pathology conference held by the division of rheumatology at hospital for special surgery. HSS J. 2014;10:286\u201391. https:\/\/doi.org\/10.1007\/s11420-014-9405-9.","journal-title":"HSS J"},{"key":"548_CR15","first-page":"18040","volume":"9","author":"Z Hou","year":"2016","unstructured":"Hou Z, Lin L, Gong Y, Wang D, Xiao Z. Leprosy mimicking connective tissue disease: a challenge for rheumatologists. Int J Clin Exp Med. 2016;9:18040\u20136. https:\/\/ijcem.com\/files\/ijcem0025796.pdf. Accessed August 20, 2025.","journal-title":"Int J Clin Exp Med"},{"key":"548_CR16","doi-asserted-by":"publisher","first-page":"81","DOI":"10.15570\/actaapa.2017.25","volume":"26","author":"V Zawar","year":"2017","unstructured":"Zawar V, Kumavat S, Pawar M, Desai D. Tuberculoid leprosy masquerading as systemic lupus erythematosus: an interesting observation. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26:81\u20133. https:\/\/doi.org\/10.15570\/actaapa.2017.25.","journal-title":"Acta Dermatovenerol Alp Pannonica Adriat"},{"key":"548_CR17","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.piel.2017.01.014","volume":"32","author":"C P\u00e9rez-Madrid","year":"2018","unstructured":"P\u00e9rez-Madrid C, Beltr\u00e1n Alzate JC, V\u00e9lez Lagoueyte N, Alba Amarillo V. Lepra lepromatosa simulando lupus eritematoso sist\u00e9mico. Piel. 2018;32:414\u20138. https:\/\/doi.org\/10.1016\/j.piel.2017.01.014.","journal-title":"Piel"},{"key":"548_CR18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.13181\/mji.v28i1.1793","volume":"28","author":"N Kusumaningrum","year":"2019","unstructured":"Kusumaningrum N, Purnamawati S, Winarni DRA, Soebono H. Lepromatous leprosy mimicking systemic lupus erythematosus: a case report. Med J Indones. 2019;28:77\u201381. https:\/\/doi.org\/10.13181\/mji.v28i1.1793.","journal-title":"Med J Indones"},{"key":"548_CR19","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.abd.2019.12.007","volume":"95","author":"LDM G\u00f3es","year":"2020","unstructured":"G\u00f3es LDM, Scrignoli JA, Morais P, Talhari C. Case for diagnosis: infiltrated areas on the trunk. Bras Dermatol. 2020;95:652\u20134. https:\/\/doi.org\/10.1016\/j.abd.2019.12.007.","journal-title":"Bras Dermatol"},{"key":"548_CR20","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/RHU.0000000000001154","volume":"26","author":"RR Kumar","year":"2019","unstructured":"Kumar RR, Jha S, Dhooria A, Kapatia G, Dhir V. A case of leprosy misdiagnosed as lupus. J Clin Rheumatol. 2019;26:e1\u20132. https:\/\/doi.org\/10.1097\/RHU.0000000000001154.","journal-title":"J Clin Rheumatol"},{"key":"548_CR21","doi-asserted-by":"publisher","first-page":"49","DOI":"10.4038\/jccp.v52i1.7930","volume":"52","author":"MMPT Jayasekera","year":"2021","unstructured":"Jayasekera MMPT, Govindapala BGDS, Samarawickrama T, et al. Lepromatous leprosy mimicking systemic lupus erythematosus. J Ceylon Coll Physicians. 2021;52:49\u201352. https:\/\/doi.org\/10.4038\/jccp.v52i1.7930.","journal-title":"J Ceylon Coll Physicians"},{"key":"548_CR22","doi-asserted-by":"publisher","first-page":"e251497","DOI":"10.1136\/bcr-2022-251497","volume":"15","author":"S Shoela","year":"2022","unstructured":"Shoela S, Eshak N, Beltagy A, Abdelnabi M. Multibacillary leprosy with positive serology misdiagnosed as systemic lupus erythematosus. BMJ Case Rep. 2022;15:e251497. https:\/\/doi.org\/10.1136\/bcr-2022-251497.","journal-title":"BMJ Case Rep"},{"key":"548_CR23","doi-asserted-by":"publisher","first-page":"189","DOI":"10.30491\/ijtmgh.2024.431402.1396","volume":"12","author":"C Valdatta","year":"2024","unstructured":"Valdatta C, Donisi A, Giulia P, Tagliaferri G, Zangrandi A. A case of borderline leprosy revealed by immunosuppressive treatment for systemic lupus erythematosus. Int J Travel Med Glob Health. 2024;12:189\u201393. https:\/\/doi.org\/10.30491\/ijtmgh.2024.431402.1396.","journal-title":"Int J Travel Med Glob Health"},{"key":"548_CR24","doi-asserted-by":"publisher","first-page":"274","DOI":"10.24875\/PJDV.24000025","volume":"82","author":"CS Oliveira","year":"2024","unstructured":"Oliveira CS, Mendes-Alexandre IC, Ezaguy-de Hollanda L, et al. Borderline lepromatous leprosy mimicking lupus vasculitis: a rare case report from the Brazilian Amazon. Port J Dermatol Venereol. 2024;82:274\u20137. https:\/\/doi.org\/10.24875\/PJDV.24000025.","journal-title":"Port J Dermatol Venereol"},{"key":"548_CR25","doi-asserted-by":"publisher","first-page":"15","DOI":"10.51559\/balidervenaesthj.v7i1.87","volume":"7","author":"E Wijaya","year":"2024","unstructured":"Wijaya E, Komarasari E, Esti PK. Case report of a 28-year-old woman with lepromatous leprosy mimicking systemic lupus erythematosus. Bali Dermatol Venereol Aesthetic J. 2024;7:15\u20138. https:\/\/doi.org\/10.51559\/balidervenaesthj.v7i1.87.","journal-title":"Bali Dermatol Venereol Aesthetic J"},{"key":"548_CR26","doi-asserted-by":"publisher","first-page":"116622","DOI":"10.1016\/j.diagmicrobio.2024.116622","volume":"111","author":"Y Zhao","year":"2024","unstructured":"Zhao Y, Huang S, Wu T. Mycobacterium leprae infection with rash misdiagnosed as a flare-up of systemic lupus erythematosus: a case report. Diagn Microbiol Infect Dis. 2024;111:116622. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2024.116622.","journal-title":"Diagn Microbiol Infect Dis"},{"key":"548_CR27","doi-asserted-by":"publisher","first-page":"e2024100","DOI":"10.47276\/lr.96.1.2024100","volume":"96","author":"M Singhal","year":"2025","unstructured":"Singhal M, Gadkar SS, More YE, Palaskar NM. A diagnostic odyssey: leprosy simulating connective tissue disorder. Lepr Rev. 2025;96:e2024100. https:\/\/doi.org\/10.47276\/lr.96.1.2024100.","journal-title":"Lepr Rev"},{"key":"548_CR28","unstructured":"Minist\u00e9rio da Sa\u00fade (BR). Boletim epidemiol\u00f3gico de hansen\u00edase: n\u00famero especial, janeiro de 2025. Bras\u00edlia (DF): Minist\u00e9rio da Sa\u00fade. 2025. https:\/\/www.gov.br\/saude\/pt-br\/centrais-de-conteudo\/publicacoes\/boletins\/epidemiologicos\/especiais\/2025\/boletim-epidemiologico-de-hanseniase-numero-especial-jan-2025.pdf"},{"key":"548_CR29","doi-asserted-by":"publisher","unstructured":"George AE, Venkatta RB. Lupus in the guise of pure neuritic leprosy. J Skin Sex Transm Dis 20202;2:122\u20135. https:\/\/doi.org\/10.25259\/JSSTD_16_2020","DOI":"10.25259\/JSSTD_16_2020"},{"key":"548_CR30","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1093\/rheumatology\/keq264","volume":"49","author":"S Chauhan","year":"2010","unstructured":"Chauhan S, Wakhlu A, Agarwal V. Arthritis in leprosy. Rheumatology (Oxford). 2010;49:2237\u201342. https:\/\/doi.org\/10.1093\/rheumatology\/keq264.","journal-title":"Rheumatology (Oxford)"},{"key":"548_CR31","first-page":"69","volume":"96","author":"A Ketki, Singh","year":"2024","unstructured":"Ketki, Singh A, Maheshwari R, Sarode A. Rheumatological manifestations of leprosy: an observational study in a tertiary care centre in north-western India. Indian J Lepr. 2024;96:69\u201377. https:\/\/www.ijl.org.in\/published-articles\/26032024223607\/7.pdf.","journal-title":"Indian J Lepr"},{"key":"548_CR32","doi-asserted-by":"crossref","unstructured":"Dogra S, Sendhil Kumaran M, Narang T, Radotra BD, Kumar B. Clinical characteristics and outcome in multibacillary (MB) leprosy patients treated with 12 months WHO MDT-MBR: a retrospective analysis of 730 patients from a leprosy clinic at a tertiary care hospital of Northern India. Lepr Rev. 2013; 84:65\u201375. https:\/\/leprosyreview.org\/admin\/public\/api\/lepra\/website\/getDownload\/5f7a95ba2bea3004611a6997","DOI":"10.47276\/lr.84.1.65"},{"key":"548_CR33","doi-asserted-by":"publisher","first-page":"372","DOI":"10.47276\/lr.79.4.372","volume":"79","author":"SL Walker","year":"2008","unstructured":"Walker SL, Lockwood DNJ. Leprosy type 1 (reversal) reactions and their management. Lepr Rev. 2008;79:372\u201386. https:\/\/researchonline.lshtm.ac.uk\/id\/eprint\/5715\/1\/5715.pdf.","journal-title":"Lepr Rev"},{"key":"548_CR34","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.semarthrit.2011.04.001","volume":"41","author":"B Florica","year":"2011","unstructured":"Florica B, Aghdassi E, Su J, Gladman DD, Urowitz MB, Fortin PR. Peripheral neuropathy in patients with systemic lupus erythematosus. Semin Arthritis Rheum. 2011;41:203\u201311. https:\/\/doi.org\/10.1016\/j.semarthrit.2011.04.001.","journal-title":"Semin Arthritis Rheum"},{"key":"548_CR35","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1097\/WCO.0000000000001304","volume":"37","author":"W Marques","year":"2024","unstructured":"Marques W. Leprous neuropathy. Curr Opin Neurol. 2024;37:487\u201392. https:\/\/doi.org\/10.1097\/WCO.0000000000001304.","journal-title":"Curr Opin Neurol"},{"key":"548_CR36","unstructured":"Scollard DM, Gillis TP, editors. International Textbook of Leprosy. Greenville (SC): American Leprosy Missions; 2016\u2013. Available from: https:\/\/internationaltextbookofleprosy.org"},{"key":"548_CR37","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1038\/s41598-022-27256-x","volume":"13","author":"X Yang","year":"2023","unstructured":"Yang X, Dong H, Kuang YQ, et al. Long-term presence of autoantibodies in plasma of cured leprosy patients. Sci Rep. 2023;13:228. https:\/\/doi.org\/10.1038\/s41598-022-27256-x.","journal-title":"Sci Rep"},{"key":"548_CR38","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1177\/0961203316644338","volume":"25","author":"M Aringer","year":"2016","unstructured":"Aringer M, D\u00f6rner T, Leuchten N, Johnson SR. Toward new criteria for systemic lupus erythematosus \u2014 a standpoint. Lupus. 2016;25:805\u201311. https:\/\/doi.org\/10.1177\/0961203316644338.","journal-title":"Lupus"},{"key":"548_CR39","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1590\/s0037-86822011000100019","volume":"44","author":"GJ Teixeira Jr","year":"2011","unstructured":"Teixeira GJ Jr, Silva CE, Magalhaes V. Application of the diagnostic criteria for systemic lupus erythematosus to patients with multibacillary leprosy. Rev Soc Bras Med Trop. 2011;44:85\u201390. https:\/\/doi.org\/10.1590\/s0037-86822011000100019.","journal-title":"Rev Soc Bras Med Trop"},{"key":"548_CR40","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1038\/s41584-025-01318-6","volume":"21","author":"B Klein","year":"2025","unstructured":"Klein B, Billi AC, Abernathy-Close L, Kahlenberg JM. Cutaneous lupus erythematosus\u2014from pathogenesis to targeted therapy. Nat Rev Rheumatol. 2025;21:703\u201318. https:\/\/doi.org\/10.1038\/s41584-025-01318-6.","journal-title":"Nat Rev Rheumatol"},{"key":"548_CR41","doi-asserted-by":"publisher","first-page":"142","DOI":"10.4103\/0019-5154.43205","volume":"53","author":"K Banerjee","year":"2008","unstructured":"Banerjee K, Banerjee R. Management of erythema nodosum leprosum by mycophenolate mofetil. Indian J Dermatol. 2008;53:142\u20133. https:\/\/doi.org\/10.4103\/0019-5154.43205.","journal-title":"Indian J Dermatol"},{"key":"548_CR42","doi-asserted-by":"publisher","first-page":"e0005348","DOI":"10.1371\/journal.pntd.0005348","volume":"11","author":"DNJ Lockwood","year":"2017","unstructured":"Lockwood DNJ, Darlong J, Govindharaj P, et al. AZALEP: a randomized controlled trial of azathioprine to treat leprosy nerve damage and type 1 reactions in India \u2013 main findings. PLoS Negl Trop Dis. 2017;11:e0005348. https:\/\/doi.org\/10.1371\/journal.pntd.0005348.","journal-title":"PLoS Negl Trop Dis"}],"container-title":["Advances in Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42358-026-00548-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-026-00548-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-026-00548-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:02:39Z","timestamp":1788181359000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42358-026-00548-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,19]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["548"],"URL":"https:\/\/doi.org\/10.1186\/s42358-026-00548-w","relation":{},"ISSN":["2523-3106"],"issn-type":[{"value":"2523-3106","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,19]]},"assertion":[{"value":"18 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The participant signed the Informed Consent Form (ICF), and the study protocol was conducted in accordance with the principles of the Declaration of Helsinki. The research was approved by the Research Ethics Committee of the Hospital Geral de Fortaleza via Plataforma Brazil (CAAE No. 94997426.8.0000.5040.), approval opinion No 8.149.819.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from patient or their legal guardian(s) for the publication of all their data and\/or images included in the study.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Artificial intelligence tools were used to support the organization and clarity of the manuscript text. The authors carefully reviewed and edited all AI-assisted content and are fully responsible for the final version of the manuscript.","order":3,"name":"Ethics","label":"AI use disclosure","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"52"}}