Lepromatous leprosy presenting as a swelling in the neck

Area of Science:

• Neurology
• Dermatology
• Infectious Diseases

Background:

• Great auricular nerve enlargement can present as neck swelling.
• Leprosy can affect peripheral nerves, including the great auricular nerve.
• Early misdiagnosis of nerve involvement can delay appropriate treatment.

Purpose of the Study:

• To report a case of great auricular nerve enlargement due to lepromatous neuritis.
• To highlight diagnostic challenges in peripheral nerve involvement.
• To emphasize the importance of considering leprosy in differential diagnoses.

Main Methods:

• Clinical presentation of a 25-year-old electrician with a 2-year history of asymptomatic neck swelling.
• Physical examination revealing an ill-defined, hypoaesthetic macule with atrophy on the left ear pinna.
• Histopathological examination of the nerve showing lepromatous neuritis with a high bacteriological index (BI) of 5+.

Main Results:

• The neck swelling was identified as an enlarged left great auricular nerve.
• Histopathology confirmed lepromatous neuritis, a form of leprosy affecting the nerve.
• Cutaneous findings included a hypoaesthetic macule with atrophy on the ipsilateral ear.

Conclusions:

• Great auricular nerve enlargement can mimic cervical lymphadenitis.
• Lepromatous neuritis is a significant cause of peripheral nerve enlargement in leprosy.
• Prompt histopathological evaluation is crucial for accurate diagnosis and management of nerve disorders.