[Leprosy and severe neuropathy in two native Spaniards]

Area of Science:

• Neurology
• Infectious Diseases
• Dermatology

Background:

• Leprosy is an infectious disease causing skin and nerve damage, often in areas with poor living conditions.
• Neuropathy, characterized by sensory deficits and nerve entrapment, is a common and significant manifestation of leprosy.
• While historically associated with endemic regions, leprosy can occur in non-endemic areas, even in native populations.

Observation:

• Two native Spanish patients presented with 'glove and stocking' paresthesias, dysesthesias, and significant gait disturbances.
• Both patients were diagnosed with borderline lepromatous leprosy, exhibiting severe, diffuse sensory-motor axonal polyneuropathy and nerve entrapment.
• Neurological symptoms predominated over dermatological manifestations in both cases.

Findings:

• The study identified severe, diffuse sensory-motor axonal polyneuropathy as the primary symptom in two Spanish leprosy patients.
• Rapid progression of neuropathies was observed, potentially linked to a change in immunological 'polarity'.
• Neurological deficits were disproportionately severe compared to the skin manifestations.

Implications:

• These cases underscore the importance of considering leprosy as a cause of neuropathy in non-endemic countries, even in individuals without a clear history of exposure.
• The findings suggest a need to broaden the diagnostic perspective for leprosy beyond traditional epidemiological links.
• Early recognition and treatment of leprosy-induced neuropathy are crucial for managing patient outcomes.