{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:20:08Z","timestamp":1787840408064,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Leprosy is a silent disease with protean manifestations, especially during lepra reactions (LRs). Cases with atypical leprosy or LR simulate a number of conditions misdiagnosed frequently. Here, three classical cases of leprosy are reported for their complex presentation. Leprosy was hidden in Case 1 due to co-existing diabetes. COVID vaccination induced LR unmasked all leprosy lesions, which were extensive, large, bizarre and spreading to various immune zones. Case 2 presented with high-grade fever, tachycardia, generalized erythema and body aches. A detailed workup unveiled his leprosy with a rare presentation of Type 1 lepra reaction (T1LR) with erythroderma and severe systemic symptoms. Case 3 mimicked sarcoidosis and lupus erythematosus (LE) on routine workup. She had facial lesions in the malar area, photosensitivity, joint pains, raised angiotensin-converting enzyme (ACE) levels and positive anti-nuclear antibodies. Peri-appendageal granulomas on histopathology and therapeutic response to multidrug therapy helped in the early diagnosis of leprosy.<\/jats:p>","DOI":"10.4103\/idoj.idoj_294_23","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T12:18:00Z","timestamp":1714393080000},"page":"500-503","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Lepra Reactions: Mimickers and Mirror to Unmask Complex Cases of Leprosy"],"prefix":"10.4103","volume":"15","author":[{"given":"Sandhya","family":"Kumari","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghanshyam K.","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajeet K.","family":"Negi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aakanksha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"R1-20250921","article-title":"Leprosy mimicking a diabetic dermopathy: A case report","author":"Jamani","year":"2018"},{"key":"R2-20250921","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/RHU.0000000000000379","article-title":"Leprosy masquerading as systemic rheumatic diseases","volume":"22","author":"El-Gendy","year":"2016","journal-title":"J Clin Rheumatol"},{"key":"R3-20250921","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.4269\/ajtmh.15-0052","article-title":"Complex type 2 reactions in three patients with Hansen's disease from a southern United States clinic","volume":"93","author":"Leon","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"R4-20250921","doi-asserted-by":"crossref","first-page":"7","DOI":"10.47878\/hi.1979.v4.35626","article-title":"Diabetic status in leprosy","volume":"4","author":"Nigam","year":"1979","journal-title":"Hansenol Int"},{"key":"R5-20250921","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.jiph.2012.08.001","article-title":"Diabetic status of patients with leprosy in Kuwait","volume":"5","author":"Saraya","year":"2012","journal-title":"J Infect Public Health"},{"key":"R6-20250921","first-page":"85","article-title":"Atypical presentation of leprosy in HIV","volume":"82","author":"Manjare","year":"2010","journal-title":"Indian J Lepr"},{"key":"R7-20250921","doi-asserted-by":"crossref","first-page":"e11616","DOI":"10.1097\/MD.0000000000011616","article-title":"Borderline tuberculoid leprosy mimicking sarcoidosis: A case report","volume":"97","author":"Liu","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"R8-20250921","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/S0190-9622(87)70295-3","article-title":"Autoaggressive hanseniasis","volume":"17","author":"Azulay","year":"1987","journal-title":"J Am Acad Dermatol"},{"key":"R9-20250921","first-page":"18040","article-title":"Leprosy mimicking connective tissue disease-A challenge for rheumatologists","volume":"9","author":"Hou","year":"2016","journal-title":"Int J Clin Exp Med"},{"key":"R10-20250921","first-page":"219","article-title":"Type 1 (reversal) lepra reaction in borderline leprosy with unusual clinical presentation--a case report","volume":"59","author":"Kar","year":"1987","journal-title":"Indian J Lepr"}],"container-title":["Indian Dermatology Online Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/idoj.idoj_294_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:22:14Z","timestamp":1787836934000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/idoj.idoj_294_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/idoj.idoj_294_23","relation":{},"ISSN":["2229-5178","2249-5673"],"issn-type":[{"value":"2229-5178","type":"print"},{"value":"2249-5673","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,24]]},"assertion":[{"value":"2023-04-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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