Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study

Area of Science:

• Neurology
• Infectious Diseases
• Pathology

Background:

• Leprosy neuropathy exhibits variable distribution and clinical presentations, including mononeuropathies, multiple mononeuropathies, and polyneuropathies.
• Pure neuritic leprosy (PNL) can occur without cutaneous or systemic signs, making diagnosis challenging, especially in Western countries where it is infrequently considered.
• Globalization increases the incidence of leprosy cases in non-endemic regions, necessitating awareness of its neurological manifestations.

Observation:

• This report details two cases: polyneuropathic PNL and multiple mononeuropathy in paucibacillary leprosy.
• Both cases were diagnosed via sural nerve biopsy, revealing inflammatory cell infiltration, granulomatous changes, and acid-fast bacilli within nerve fascicles.

Findings:

• Sural nerve biopsy confirmed leprosy neuropathy by demonstrating characteristic histopathological changes and the presence of Mycobacterium leprae.
• The findings underscore the diagnostic utility of nerve biopsy in identifying leprosy as a cause of neuropathy with unknown etiology.

Implications:

• The study highlights the importance of considering leprosy neuropathy in the differential diagnosis of acquired sensory polyneuropathies and multiple neuropathies, even in Western countries.
• Nerve biopsy remains a valuable diagnostic tool for elucidating the cause of unexplained neuropathies, particularly in the context of potential leprosy exposure.