A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen’s disease in Colombia

Serrano-Coll, Héctor; Mieles, Olinto; Escorcia, Calixto; Díaz, Amparo Viguri; Beltrán, Camilo; Cardona-Castro, Nora

doi:10.7705/biomedica.v38i0.3690

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…In the spectrum of clinical forms of leprosy, the pure neural form still represents a challenge for clinicians and dermatologists, especially in endemic areas for leprosy in Brasil 11,18,20,21 . Reviewing the literature on the diagnosis of pure neural leprosy is a sensitive topic in the Brazilian scientific community, mainly due to the magnitude of the endemic disease in the country.…”

Section: Discussionmentioning

confidence: 99%

“…In these cases, when the observed pattern is only of neural impairment, the physician must use other auxiliary resources that help to exclude other diseases that manifest with neuropathy and allow for confirmation of the diagnosis of neural leprosy 1,11,18,19 . Among the resources, electroneuromyography, ultrasonography 22,29,34 , biopsies of peripheral nerves 21,24 , and even magnetic resonance imaging of nerve trunks 27 stand out.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that no text addressed both themes together. Case reports, with the largest number of publications (14 investigations), stood out 11,18,20,21,[25][26][27][29][30][31]33,34,36,37 . Full-text reading (n=111)…”

Section: Systematic Reviewmentioning

confidence: 99%

“…The studies emphasized the challenging diagnosis of pure neural leprosy 16,17,25,27,30 and the need for advances in the development of diagnostic methods 18,32 , such as imaging tests (magnetic resonance imaging 27 and ultrasound 22,29,34 ), cytology and histopathology 21,23,24,28,38 , and serological and genomic tests 19,35 .…”

Section: Eligibilitty Inclusionmentioning

confidence: 99%

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Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report

Santos

Fernandes

Barbosa

et al. 2021

Rev. Assoc. Med. Bras.

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OBJECTIVE:To review the literature and to report a clinical case with initial suspicion of pure neural leprosy and final diagnosis of amyloid neuropathy. METHODS:The study was conducted in two stages. In stage one, a systematic literature review was carried out, with searches performed in the PubMed, Medline, and Lilacs databases, as well as in the leprosy sectoral library of the Virtual Health Library, using the following descriptors: neuritic leprosy, pure neural leprosy, primary neural leprosy, pure neuritic leprosy, amyloid polyneuropathy, amyloid neuropathies, and amyloid polyneuropathy. The search was carried out on May 28, 2020. Clinical trials, cohort studies, crosssectional studies, clinical cases, and case studies published in Portuguese, English or Spanish between 2010 and 2020 were included.Stage two reports a case with initial suspicion of pure neural leprosy. Laboratory tests, electroneuromyography, ultrasound, and biopsy of the sural nerve were requested.RESULTS: Twenty-three scientific texts were included. No publications were found that contained both topics together. The challenging diagnosis of pure neural leprosy and the possibility of using auxiliary resources in diagnosis were the most emphasized themes in the studies. In the clinical case, the patient's electroneuromyography showed sensitive and motor polyneuropathy of the lower limbs, which was predominantly sensory and axonal, symmetrical, of moderate intensity, and the mixed type (axonal-demyelinating). Ultrasonography of the sural nerve revealed changes in the contour of the deep fibular nerves; biopsy of the sural nerve showed an accumulation of amorphous eosinophilic material in the nerve path, and Congo red stain showed apple-green birefringence of the deposit under polarized light. The final diagnosis was amyloid neuropathy. CONCLUSIONS:The final clinical diagnosis was amyloid neuropathy. The diagnosis of pure neural leprosy in endemic areas in Brasil is still a challenge for the health system.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Section: Eligibilitty Inclusionmentioning

confidence: 99%

See 2 more Smart Citations

Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report

Santos

Fernandes

Barbosa

et al. 2021

Rev. Assoc. Med. Bras.

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“…Since intraneural inflammatory lesions in leprosy are multifocal and patchy, the peripheral neuropathy of leprosy is classified as "mononeuritis multiplex." Mononeuritis affecting a single nerve without skin lesions are classified as "pure neuritic leprosy" [32][33][34][35][36]. Neuritis triggered by intraneural inflammatory response, edema, and granuloma formation clinically produces chronic low grade nerve pain.…”

Section: Neuritis Associated With the Diseasementioning

confidence: 99%

Treatment and Evaluation Advances in Leprosy Neuropathy

Ebenezer

Scollard

2021

Neurotherapeutics

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Polineuropatia desmielinizante como manifestação inicial isolada de hanseníase

Pires

Hämmerle

Lima

et al. 2020

Medicina (Ribeirão Preto)

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Modelo do Estudo: Relato de caso Importância do problema: No mundo, mais de três milhões de pessoas estão vivendo com deficiência física devido à hanseníase. O Brasil é o segundo país com o maior número de casos novos registrados. A magnitude e o alto risco de incapacidade mantêm a doença como problema de saúde pública. O diagnóstico de hanseníase em geral é simples. Porém, quadros com ausência de lesões cutâneas características, somente com alterações neurais, representam um desafio para o diagnóstico diferencial com outras doenças neurológicas. Comentários: Relatamos o caso de um paciente encaminhado ao serviço de neurologia com história clínica e eletroneuromiografia compatíveis com polineuropatia desmielinizante, sem qualquer lesão cutânea ao exame de admissão. O raciocínio clínico inicial foi direcionado para o diagnóstico das polineuropatias desmielinizantes inflamatórias adquiridas como Polineuropatia Desmielinizante Inflamatória Crônica (CIDP) e suas variantes. No entanto, após anamnese e exame físico detalhados, chamou a atenção a ausência do componente atáxico e a presença predominante de alterações sensitivas de fibra fina, espessamento de nervo e importante fator epidemiológico para hanseníase, motivando a suspeita e a investigação desta enfermidade por meio da biópsia de nervo que foi sugestiva de hanseníase. Após três meses, em novo exame do paciente para biopsiar áreas de anestesia para reforçar o diagnóstico, observou-se o surgimento de extensas lesões levemente hipocrômicas no tronco e membros inferiores, cuja biópsia definiu o diagnóstico de hanseníase.

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A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen’s disease in Colombia

Cited by 5 publications

References 17 publications

Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report

Pure neural leprosy or amyloid neuropathy? Systematic review and clinical case report

Treatment and Evaluation Advances in Leprosy Neuropathy

Polineuropatia desmielinizante como manifestação inicial isolada de hanseníase

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