To the Editor.
—Rheumatic manifestations are well described in leprosy as part of the "lepra reaction."1 Often, but not always, erythematous skin lesions termed erythema nodosum leprosum are seen in this presumably immune complex-mediated reaction. The arthritis may involve one or more large joints, typically knees or ankles, or it may be an acute polyarthritis of the small joints of the hands and feet. As leprosy is an uncommon disease in the northeastern United States,2 it is rarely considered in patients seen with arthritis and fever. We treated a patient in whom early diagnosis of this condition may have prevented a long workup for other more common diseases.
Report of a Case.
—A 41-year-old man, who had emigrated to the United States from the Dominican Republic eight years previously, was hospitalized following five days of fever and chills associated with a right-sided supraorbital headache. He also complained of