Nerve abscess in primary neuritic leprosy

Area of Science:

• Neurology
• Infectious Diseases
• Dermatology

Background:

• Leprosy, a chronic infectious disease, primarily affects peripheral nerves.
• Nerve abscesses are an uncommon complication of leprosy, particularly in pure neuritic forms.
• Early diagnosis and treatment are crucial to prevent nerve damage and disability.

Observation:

• A patient with pure neuritic leprosy presented with sensory disturbances in the right forearm and hand.
• The patient subsequently developed localized pain, redness, and swelling around the right elbow and wrist.
• High-resolution ultrasound revealed a cystic lesion with internal debris within the thickened right ulnar nerve at the cubital tunnel.

Findings:

• Histopathological examination of the abscess confirmed granulomas and the presence of lepra bacilli.
• The nerve abscess was identified as the initial manifestation of leprosy in this patient.
• The patient showed a positive response to surgical intervention and multidrug therapy.

Implications:

• This case underscores the necessity of a high index of suspicion for leprosy when encountering nerve abscesses.
• Nerve abscesses, though rare, can be the presenting sign of leprosy, necessitating thorough diagnostic evaluation.
• Prompt diagnosis and combined surgical and medical treatment can lead to favorable outcomes in leprosy-associated nerve abscesses.