A clinicopathological and electrophysiological study of nerve involvement in leprosy in a tertiary care centre in South India

Abstract

Objectives and Methods To correlate the clinical spectrum of Hansen's disease with the histopathological spectrum in skin and nerve and to study the electrophysiological changes in peripheral nerves in Hansen's disease. Thirty-five consecutive attendees with leprosy were recruited for the study from a tertiary dermatology clinic. Results Clinically, borderline tuberculoid (BT) classification was the commonest subtype with 34% cases, followed by borderline lepromatous (BL) and lepromatous (LL). The incidence of multibacillary (MB) cases was high (83%) and grade 2 disability was seen in 23% cases. Concordance between clinical diagnosis and skin histopathology was 75.8%, while between clinical diagnosis and nerve histopathology was 68%. Skin and nerve histopathology were in concordance in 60% of cases. Electrophysiological assessment revealed derangement in 88.5% of cases with sensory nerve conduction parameters being the commonest and earliest to be affected. Analysis revealed a significant association between deranged parameters and thickness of the superficial peroneal nerve, sural and common peroneal nerves. Subclinical involvement was high in most nerves studied. Cases at the tuberculoid end of the spectrum showed more of segmental demyelination, whereas lepromatous cases showed a mixture of axonal and demyelinating changes. Conclusion A high degree of concordance was seen between dermal and nerve histopathologies, especially towards the poles of the leprosy spectrum. With an increasing trend towards MB cases and grade 2 disability, our study validates nerve