- Discussion:
- causative organism of leprosy is M. leprae;
- acid-fast, obligate, intracellular gram-positive bacillus that reproduces maximally at 27°C to 30°C;
- frequent subacute polyarthritis involving the small joints of the hands and feet;
- organism infects the skin and cutaneous nerves, its principal target being the Schwann-cell basal lamina;
- direct bacterial infection may lead to osteomyelitis or periostitis;
- dx: may require
sural nerve biopsy;
- Fite's modification of the Ziehl–Neelsen acid-fast stain for mycobacteria may show bacilli in Schwann cells;
- hematoxylin and eosin stain: inflammatory infiltrate w/ plasma cells and lymphocytes and poorly formed aggregates of histiocytes;
- electron micrograph: loss of unmyelinated axons, manifested by the presence of so-called empty Schwann-cell stacks;
- ref: Value of nerve biopsy in the diagnosis and follow-up of leprosy: the role of vascular lesions and usefulness of nerve studies in the detection of persistent bacilli.
Chimelli L et al.
J Neurol 1997;244:318-323
- Exam:
- doess not follow the anatomic distribution of the subcutaneous sensory nerves, of the mixed nerve trunks, of the sensory roots,
or of the distal symmetrical sensory loss
- nerves are often involved in subcutaneous regions (bacteria thrive in cooler regions of the body);
-
ulnar nerve is often involved at the elbow (treatment is
submuscular transposition);
-
median nerve may be involved at the wrist;
- hand involvement;
- painful dysesthesias
- sensory loss more pronounced on the dorsal than on the palmar surfaces;
- Treatment:
- dapsone and
rifampin;
Bone changes in Leprosy: a correlation of clinical and radiographic features.
ED Carl et al.
Radiology. Vol 100. 1971. p 295-306.
Clinical and Laboratory studies of arthritis in leprosy.
SL Atkin et al.
Br Medical Journal. Vol 298. 1989. p 1423-1425.
Rheumatic manifestations of leprosy: clinical aspects.
JC Almeida Pernambuco et al.
J. Rheumatology. 1993. Vol 20. p 897-899.
Case 1-2004 — A 49-Year-Old Woman with Asymmetric Painful Neuropathy
Temperature-linked sensory loss: a unique pattern in leprosy. Sabin TD. Arch Neurol 1969;20:257-262
