Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study
The extent of nerve involvement in leprosy is highly variable in distribution and clinical presentation. Mononeuropathies, multiple mononeuropathies, and polyneuropathies can present both in the context of a cutaneous and/or systemic picture and in the form of pure neuritic leprosy (PNL). The differ...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-09-01
|
| Series: | Biomedicines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9059/11/9/2468 |
| _version_ | 1797581203585368064 |
|---|---|
| author | Stefano Cotti Piccinelli Matteo Tagliapietra Tiziana Cavallaro Beatrice Labella Barbara Risi Filomena Caria Simona Damioli Loris Poli Alessandro Padovani Sergio Ferrari Massimiliano Filosto |
| author_facet | Stefano Cotti Piccinelli Matteo Tagliapietra Tiziana Cavallaro Beatrice Labella Barbara Risi Filomena Caria Simona Damioli Loris Poli Alessandro Padovani Sergio Ferrari Massimiliano Filosto |
| author_sort | Stefano Cotti Piccinelli |
| collection | DOAJ |
| description | The extent of nerve involvement in leprosy is highly variable in distribution and clinical presentation. Mononeuropathies, multiple mononeuropathies, and polyneuropathies can present both in the context of a cutaneous and/or systemic picture and in the form of pure neuritic leprosy (PNL). The differential diagnosis of leprosy neuropathy remains challenging because it is a very rare condition and, especially in Western countries, is often overlooked. We report one case of the polyneuropathic form of PNL (P-PNL) and one case of multiple mononeuropathy in paucibacillary leprosy. In both cases, the diagnosis was achieved by performing a sural nerve biopsy, which showed subverted structure, severe infiltration of inflammatory cells in nerve fascicles, granulomatous abnormalities, and the presence of alcohol-acid-resistant, Ziehl–Neelsen-positive bacilli inside the nerve bundles. Leprosy remains an endemic disease in many areas of the world, and globalization has led to the spread of cases in previously disease-free countries. In this perspective, our report emphasizes that the diagnostic possibility of leprosy neuropathy should always be taken into account, even in Western countries, in the differential diagnostic process of an acquired sensory polyneuropathy or multineuropathy and confirms that nerve biopsy remains a useful procedure in working up neuropathies with unknown etiology. |
| first_indexed | 2024-03-10T23:00:55Z |
| format | Article |
| id | doaj.art-f66554232a7b4971befb624256e0da09 |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-10T23:00:55Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-f66554232a7b4971befb624256e0da092023-11-19T09:41:45ZengMDPI AGBiomedicines2227-90592023-09-01119246810.3390/biomedicines11092468Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological StudyStefano Cotti Piccinelli0Matteo Tagliapietra1Tiziana Cavallaro2Beatrice Labella3Barbara Risi4Filomena Caria5Simona Damioli6Loris Poli7Alessandro Padovani8Sergio Ferrari9Massimiliano Filosto10Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, ItalyNeurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, ItalyNeurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, ItalyNeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, ItalyNeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, ItalyUnit of Neurology, ASST Spedali Civili, 25100 Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, ItalyNeurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, ItalyThe extent of nerve involvement in leprosy is highly variable in distribution and clinical presentation. Mononeuropathies, multiple mononeuropathies, and polyneuropathies can present both in the context of a cutaneous and/or systemic picture and in the form of pure neuritic leprosy (PNL). The differential diagnosis of leprosy neuropathy remains challenging because it is a very rare condition and, especially in Western countries, is often overlooked. We report one case of the polyneuropathic form of PNL (P-PNL) and one case of multiple mononeuropathy in paucibacillary leprosy. In both cases, the diagnosis was achieved by performing a sural nerve biopsy, which showed subverted structure, severe infiltration of inflammatory cells in nerve fascicles, granulomatous abnormalities, and the presence of alcohol-acid-resistant, Ziehl–Neelsen-positive bacilli inside the nerve bundles. Leprosy remains an endemic disease in many areas of the world, and globalization has led to the spread of cases in previously disease-free countries. In this perspective, our report emphasizes that the diagnostic possibility of leprosy neuropathy should always be taken into account, even in Western countries, in the differential diagnostic process of an acquired sensory polyneuropathy or multineuropathy and confirms that nerve biopsy remains a useful procedure in working up neuropathies with unknown etiology.https://www.mdpi.com/2227-9059/11/9/2468sensory polyneuropathyleprosypure leprosy neuropathymultiple mononeuropathy |
| spellingShingle | Stefano Cotti Piccinelli Matteo Tagliapietra Tiziana Cavallaro Beatrice Labella Barbara Risi Filomena Caria Simona Damioli Loris Poli Alessandro Padovani Sergio Ferrari Massimiliano Filosto Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study Biomedicines sensory polyneuropathy leprosy pure leprosy neuropathy multiple mononeuropathy |
| title | Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study |
| title_full | Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study |
| title_fullStr | Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study |
| title_full_unstemmed | Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study |
| title_short | Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study |
| title_sort | leprosy neuropathy in a non endemic area a clinical and pathological study |
| topic | sensory polyneuropathy leprosy pure leprosy neuropathy multiple mononeuropathy |
| url | https://www.mdpi.com/2227-9059/11/9/2468 |
| work_keys_str_mv | AT stefanocottipiccinelli leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT matteotagliapietra leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT tizianacavallaro leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT beatricelabella leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT barbararisi leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT filomenacaria leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT simonadamioli leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT lorispoli leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT alessandropadovani leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT sergioferrari leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy AT massimilianofilosto leprosyneuropathyinanonendemicareaaclinicalandpathologicalstudy |