Immunohistochemical study of cutaneous neuritis in positive lepromin reactions

Sixty skin biopsies taken from positive tuberculoid and borderline-tuberculoid late lepromin reaction were studied using histological techniques. The distribution of mycobacterial antigen and nerves was demonstrated using immunochemical methods. A total of 557 nerve bundles was observed in 51 biopsies; 9 were devoid of nerves in the sections examined; 475 nerve bundles showed some relationship to the inflammatory infiltrate (85%); perineuritis being seen in 144 (30%) and endoneuritis in 5 (0.9%). Mycobacterial antigens inside the granuloma were detected in 59 of the 60 biopsies (98%). Only one specimen, showing a strong tuberculoid reaction, failed to show these antigens. On the contrary, mycobacterial antigen was absent in almost all nerves. Small deposits were detected in the perineurium of one nerve with perineuritis, and inside a Schwann cell of another, the latter belonging to a previously multibacillary patient. The neurotropic tendency of the granuloma does not seem to be stimulated by the presence of mycobacterial antigens inside the nerves, as normally these antigens do not penetrate them. The hypothesis of some antigenic fraction of the neural tissue which cross-reacts with Mycobacterium leprae antigens, thus eliciting a perineural or near-perineural inflammatory reaction is put forward, but needs further investigation.