{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:16:41Z","timestamp":1790180201825,"version":"4.1.0"},"reference-count":10,"publisher":"FapUNIFESP (SciELO)","issue":"6","license":[{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects mainly the skin and peripherical nerves. Brasil has not yet achieved its goal of elimination of the number of cases of this disease, ranking second in terms of absolute numbers worldwide, with India occupying the first position. Primary Neural Leprosy is considered to be a challenge in diagnosis, since it affects the peripherical nerve system with the absence of skin lesions, thus mimicking rheumatological disorders, like in the case presented. A male, 31, with no previous comorbidities, five years ago, started feeling severe pain in the left ankle as well as morning hand pain and stiffness. After many years of being submitted to intense rheumatological disease investigation, they all proved to be negative. Upon physical examination, the patient presented no skin lesions, symmetric polyarthritis in metacarpophalangeal joints and thickness of the left sural nerve. Lab exams showed no alterations and bacilloscopy was negative. Ultrasonography was used to investigate the thickness of the left sural nerve. Biopsy showed a minimal amount of perineural lymphocytes and positive AFB testing. Based on the electroneuromyography, the conclusion was multiple mononeuropathy, and multibacillary polychemotherapy was started. Leprosy remains a public health problem in Brasil. Due to the high prevalence of the disease, our medical colleagues must be alert and trained to recognize this clinical presentation of leprosy. Correct referral to Reference Centers accelerates research, contributing to an accurate diagnosis, classification, and treatment, thus preventing irreversible sequelae with severe functional disability.<\/jats:p>","DOI":"10.1590\/1806-9282.65.6.767","type":"journal-article","created":{"date-parts":[[2019,7,20]],"date-time":"2019-07-20T19:06:56Z","timestamp":1563649616000},"page":"767-770","source":"Crossref","is-referenced-by-count":5,"title":["Primary Neural Leprosy mimicking rheumatological disorders"],"prefix":"10.1590","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1246-1790","authenticated-orcid":false,"given":"Renata Carolina Schl\u00f6gel de","family":"Freitas","sequence":"first","affiliation":[{"name":"Pr\u00f3 Hansen Foundation, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0074-4010","authenticated-orcid":false,"given":"Carlos Augusto Zanardini","family":"Pereira","sequence":"additional","affiliation":[{"name":"Pr\u00f3 Hansen Foundation, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5500-4744","authenticated-orcid":false,"given":"Nadia Tannous","family":"Muri","sequence":"additional","affiliation":[{"name":"Pr\u00f3 Hansen Foundation, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9341-9449","authenticated-orcid":false,"given":"Val\u00e9ria Aparecida Zanela","family":"Franzon","sequence":"additional","affiliation":[{"name":"Pr\u00f3 Hansen Foundation, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6357-4277","authenticated-orcid":false,"given":"Carlos Alberto Camorim","family":"Fatuch","sequence":"additional","affiliation":[{"name":"Pr\u00f3 Hansen Foundation, Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2019,6]]},"reference":[{"issue":"9-B","key":"ref1","first-page":"661","article-title":"Leprosy neuropathy: clinical presentations","volume":"1","author":"Nascimento OJ","journal-title":"Arq Neurop"},{"issue":"2","key":"ref2","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1590\/abd1806-4841.20142450","article-title":"Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects \u2013 part 1","volume":"89","author":"Last\u00f3ria JC","year":"2014","journal-title":"An Bras Dermatol"},{"issue":"11","key":"ref3","article-title":"Revisiting primary neural leprosy: clinical, serological, molecular, and neurophysiological aspects","volume":"11","author":"Santos DFD","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"ref4","first-page":"328","article-title":"Artrite como diagn\u00f3stico de hansen\u00edase: relato de caso e revis\u00e3o da literatura","volume":"89","author":"Fernandes TRMO","year":"2014","journal-title":"An Bras Dermatol"},{"key":"ref5","series-title":"Hansen\u00edase forma neural pura: aspectos cl\u00ednicos e eletroneuromiogr\u00e1ficos dos pacientes avaliados no servi\u00e7o de doen\u00e7as neuromusculares do HCRP da USP no per\u00edodo de mar\u00e7o de 2001 a mar\u00e7o de 2013 [Disserta\u00e7\u00e3o de mestrado]","author":"Tomaselli PJ","year":"2014"},{"key":"ref6","series-title":"Altera\u00e7\u00f5es neurol\u00f3gicas na forma neural pura da hansen\u00edase: aplica\u00e7\u00e3o do grau de incapacidade f\u00edsica e da classifica\u00e7\u00e3o internacional de funcionalidade, incapacidade e sa\u00fade [Disserta\u00e7\u00e3o de mestrado]","author":"Castro FRS","year":"2012"},{"key":"ref7","series-title":"Hansen\u00edase neural prim\u00e1ria. Projeto Diretrizes","author":"Garbino JA","year":"2011"},{"issue":"2","key":"ref8","doi-asserted-by":"crossref","first-page":"203","DOI":"10.47878\/hi.2007.v32.36306","article-title":"O paciente com suspeita de hansen\u00edase primariamente neural","volume":"32","author":"Garbino JA","year":"2007","journal-title":"Hansen Int"},{"issue":"2","key":"ref9","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/j.1756-185X.2012.01819.x","article-title":"Leprosy revealed in a rheumatology clinic: a case series","volume":"16","author":"Prasad S","year":"2013","journal-title":"Int J Rheum Dis"},{"issue":"6","key":"ref10","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1590\/0004-282X20130046","article-title":"Primary neural leprosy: systematic review","volume":"71","author":"Garbino JA","year":"2013","journal-title":"Arq Neuropsiquiatr"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ramb\/v65n6\/1806-9282-ramb-65-06-0767.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,21]],"date-time":"2024-07-21T06:38:55Z","timestamp":1721543935000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302019000600767&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":10,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["S0104-42302019000600767"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.65.6.767","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}