Demyelinating polyneuropathy as an isolated initial manifestation of leprosy
case report
DOI:
https://doi.org/10.11606/issn.2176-7262.v53i1p73-79Keywords:
Leprosy, Mycobacterium leprae, Polyneuropathies, Mononeuropathies, Mycobacterium Infections, Diagnosis, DifferentialAbstract
Study: Case report.
Importance: Worldwide over three million people are living with disabilities due to leprosy. Brazil is the second country with the highest number of new cases registered. The magnitude and high risk of disability make the disease a public health problem. The diagnosis of leprosy can be simple. However, in the absence of skin lesions and with many possibilities of neurological impairment, diagnosis can become a challenge.
Comments: We report the case of a patient referred to the neurology service with a clinical history and electrophysiological tests compatible with demyelinating polyneuropathy, without any skin lesion at admission examination. The initial clinical research was directed to the diagnosis of acquired inflammatory demyelinating polyneuropathies such as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and its variants. However, after anamnesis and detailed physical examination, the absence of the ataxic component and the predominant presence of sensory alterations of fine fiber, nerve thickening and important epidemiological factor for leprosy, led to the suspicion and investigation of this disease by nerve biopsy that was suggestive of leprosy. After three months, in a new patient examination to biopsy areas of anesthesia to reinforce the diagnosis, there was the appearance of extensive slightly hypochromic lesions in the trunk and lower limbs, whose biopsy defined the diagnosis of leprosy.
Downloads
References
2. Garbino JA, Heise CO, Marques W Jr. Assessing nerves in leprosy. Clinics in Dermatology 2016 Jan-Feb;34(1):51-8. Epub 2015 Nov 6. doi: 0.1016/j.clindermatol.2015.10.018. PMID:26773623
3. Secretaria de Vigilância em Saúde – Ministério da Saúde. Boletim Epidemiológico. Brasil. 2018.
Disponível em: http://portalarquivos2.saude.gov.br/images/pdf/2018/janeiro/31/2018-004-Hanseniase-publicacao.pdf
4. Ministério da Saúde. - Secretaria de vigilância em saúde. Boletim Epidemiológico Hanseníase. Brasil. Volume 49 N° 4 – 2018. ISSN 2358-9450. Disponível em: http://portalarquivos2.saude.gov.br/images/pdf/2018/janeiro/31/2018-004-Hanseniase-publicacao.pdf
5. Araújo, MG. Leprosy in Brazil. Rev Soc Bras Med Trop. 2003 May-Jun;36(3):373-82. Epub 2003 Jul 31. PMID: 12908039
6. Fischer M. Leprosy - an overview of clinical features, diagnosis, and treatment. J Dtsch Dermatol Ges. 2017 Aug;15(8):801-827. doi: 10.1111/ddg.13301.
7. Allen JA. Chronic Demyelinating Polyneuropathies. Continuum (Minneap Minn). 2017 Oct;23(5, Peripheral Nerve and Motor Neuron Disorders):1310-1331. doi: 10.1212/CON.0000000000000517.
8. DAHW Brasil. Disponível em : https://www.dahw.org.br/situacao-da-hanseniase-no-brasil/?gclid=Cj0KCQiA2b7uBRDsARIsAEE9XpHA5X0SHbW751Oq3yfc0-f8TpJ0Mvg-3A9cMcjk2Tf6jqc-CmzTYV0aAmPKEALw_wcB#utm_source=Google&utm_medium=CPC&utm_campaign=Ads
9. Garbino JA, Jardim MR, Marques JR W, Antunes SL, Soares CT, Heise CO, et al. Hanseníase Neural Primária. Projeto Diretrizes. Fundação Oswaldo Cruz – Rio de Janeiro, Instituto Lauro de Souza Lima – Bauru – São Paulo. 2011. Disponível em: http://www.saudedireta.com.br/docsupload/1331157146hanseniase_neural_primaria.pdf
10. Tomaselli, Pedro José. Hanseníase forma neural pura: aspectos clínicos e eletroneuromiográficos dos pacientes avaliados no serviço de doenças neuromusculares do HCRP da USP no período de março de 2001 a março de 2013. Ribeirão Preto: Faculdade de Medicina de Ribeirão Preto. 2014. doi: 10.11606/D.17.2014.tde-13072014-130102
11. Serrano-Coll H, Mieles O, Escorcia C, Díaz A, Beltrán C, Cardona-Castro N. A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen's disease in Colombia. Biomedica. 2018 Jun 15;38(2):153-161.doi: 0.7705/biomedica.v38i0.3690.
Downloads
Published
Issue
Section
License