Sir,
A 53-yeal old male presented to us with history of loss of sensations over the hands and feet with recurrent ulceration over the fingers for the last three years. Over a period of next two years, he also noticed multiple skin colored to erythematous nodular lesions over the trunk and the buttocks and there was gradual progression of the sensory loss with loss of distal ends of a few digits. For the last three months, the patient gave history of persistent swelling of the right middle finger and a large reddish oozing mass over the right palm, which had developed at the site of previous ulceration. There was also history of recurrent epistaxis and stuffiness of nose with congestion and watering of the eyes. On examination, there was diffuse swelling of the right middle finger with fingertip ulceration destruction of nail plate and the presence of a protuberant reddish mass over the right palm (Figs.
Sausage appearance of right middle finger with loss of distal phalanges of little finger.
Pyogenic granuloma over the palm with fingertip ulceration over middle finger.
Radiological examination showing soft tissue swelling with destruction of middle phalanx of middle finger and loss of distal phalanges of little finger.
Leprosy, a chronic granulomatous infection caused by Mycobacterium leprae, classically manifests with cutaneous and neurological manifestations. Musculoskeletal involvement though third most common is frequently underdiagnosed and underreported. It may manifest in the form of Charcot’s arthropathy, acute symmetrical polyarthritis or swollen hands and feet syndrome during lepra reactions, insidious-onset chronic symmetrical polyarthritis mimicking rheumatoid arthritis or as isolated tenosynovitis or tenosynovitis associated with arthritis or neuropathy. Banana finger (sausage appearance of digits) is a frequent clinical finding in leprous dactylitis and is commonly seen as a manifestation of Type 2 lepra reaction [