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An unusual cause of mononeuritis multiplex
1Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK. shuda@nhs.net
Practical Neurology
|January 15, 2013
Summary
Leprosy can mimic mononeuritis multiplex, presenting as nerve damage. Early diagnosis is crucial for effective treatment of this infectious neuropathy.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Mononeuritis multiplex is a neurological condition characterized by damage to multiple individual peripheral nerves.
- Differential diagnosis for mononeuritis multiplex can be extensive, including various inflammatory, infectious, and neoplastic causes.
Observation:
- A middle-aged South Asian male presented with progressive bilateral sensory disturbances in median nerve distribution and feet.
- Neurological examination revealed patchy sensory loss on nerve conduction studies and electromyography (NCS/EMG), progressing to involve multiple nerves.
- Facial nerve and trigeminal nerve involvement, along with hypopigmentation, were observed.
Findings:
- Nerve conduction studies and electromyography confirmed mononeuritis multiplex predominantly affecting sensory fascicles.
- Skin and sural nerve biopsies showed chronic granulomatous inflammation without Mycobacterium.
- Slit skin smear test identified Mycobacterium leprae, confirming primary neuritic leprosy.
Implications:
- This case highlights that leprosy should be considered in the differential diagnosis of mononeuritis multiplex, especially in endemic areas or specific ethnic groups.
- Primary neuritic leprosy can present atypically, emphasizing the need for comprehensive diagnostic workup.
- Timely diagnosis and treatment of leprosy are essential to prevent further neurological damage and disability.
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