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Area of Science:

  • Neurology
  • Infectious Diseases
  • Dermatology

Background:

  • Leprosy (Hansen's disease) is a chronic infectious disease with diverse clinical presentations.
  • Pure neuritic leprosy is an uncommon variant characterized by nerve damage without typical skin manifestations.
  • Peripheral neuropathy symptoms, such as pain, numbness, and muscle atrophy, can indicate nerve involvement.

Purpose of the Study:

  • To highlight the diagnostic challenges and clinical features of pure neuritic leprosy.
  • To emphasize the importance of considering leprosy in the differential diagnosis of peripheral neuropathies, especially in endemic regions.
  • To underscore the necessity of prompt diagnosis and management to prevent irreversible neurological deficits.

Main Methods:

  • Case report of an 11-year-old male presenting with progressive arm swelling, finger deformities, and numbness.
  • Clinical examination revealed a palpable nerve lesion, positive Tinel's sign, claw hand deformity, and muscle atrophy.
  • Diagnostic tools included electro-diagnostic testing (nerve conduction studies) and magnetic resonance imaging (MRI) of the affected arm.
  • Surgical exploration with ulnar nerve decompression and biopsy was performed for definitive diagnosis.

Main Results:

  • Electro-diagnostic tests indicated a right ulnar axonal neuropathy.
  • MRI showed a thickened ulnar nerve with a well-defined, hyperintense lesion.
  • Histopathological examination of the nerve biopsy revealed necrotizing granulomatous inflammation consistent with tuberculoid leprosy (Hansen's disease).
  • Acid-fast bacilli staining was negative.

Conclusions:

  • Pure neuritic leprosy should be considered in the differential diagnosis of peripheral neuropathies, particularly in leprosy-endemic areas.
  • Early recognition and treatment are essential to avert permanent neurological damage.
  • This case underscores the varied presentations of Hansen's disease and the importance of comprehensive diagnostic evaluation.