On the spectrum of leprosy neuropathies: Multifocal inflammatory neuropathy heralding leprosy relapse

Gondim, Francisco de Assis Aquino; Thomas, Florian P.; Oliveira, Gisele R. de; Pimentel, Leonardo Halley Carvalho; Bastos, Bruno Pamplona Ranieri; Costa, Carlos Maurício de Castro

doi:10.1016/j.nmd.2009.05.007

Cited by 4 publications

(5 citation statements)

References 7 publications

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“… 19 Hulmani et al 20 hypothesised that late worsening of symptoms in LL patients may occur due to the persistence of the bacillus or reinfection and suggested that patients maintain treatment with MDT until the smear becomes negative. The results of Gondim et al 21 demonstrated an increase in cerebrospinal fluid protein levels, suggesting immune-mediated neuropathy in these patients.…”

Section: Discussionmentioning

confidence: 81%

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy

Penna

Pitta

Vital

et al. 2022

Mem. Inst. Oswaldo Cruz

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BACKGROUND The lepromatous pole is a stigmatising prototype for patients with leprosy. Generally, these patients have little or no symptoms of peripheral nerve involvement at the time of their diagnosis. However, signs of advanced peripheral neuropathy would be visible during the initial neurological evaluation and could worsen during and after multidrug therapy (MDT). Disabilities caused by peripheral nerve injuries greatly affect these patients’ lives, and the pathophysiological mechanisms underlying nerve damage remain unclear. OBJECTIVES To evaluate the outcome of peripheral neuropathy in patients with lepromatous leprosy (LL) and persistent neuropathic symptoms years after completing MDT. METHODS We evaluated the medical records of 14 patients with LL who underwent nerve biopsies due to worsening neuropathy at least four years after MDT. FINDINGS Neuropathic pain developed in 64.3% of the patients, and a neurological examination showed that most patients had alterations in the medium- and large-caliber fibers at the beginning of treatment. Neurological symptoms and signs deteriorated despite complete MDT and prednisone or thalidomide use for years. Nerve conduction studies showed that sensory nerves were the most affected. MAIN CONCLUSIONS Patients with LL can develop progressive peripheral neuropathy, which continues to develop even when they are on long-term anti-inflammatory and immunosuppressive therapy.

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Section: Discussionmentioning

confidence: 81%

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy

Penna

Pitta

Vital

et al. 2022

Mem. Inst. Oswaldo Cruz

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“…Her condition improved without any steroid therapy. The authors suggest the hypothesis that the cell injury caused by type II reaction exposed neural antigens and caused an autoimune reaction, leading to the acute neuropathy [23,24].…”

Section: Discussionmentioning

confidence: 99%

Chronic Inflammatory Demyelinating Polyneuropathy In A Patient With A Leprosy Reversal Reaction: A Case Report

2017

AIDT

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Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that affects the peripheral nervous system with progressive limb weakness, with predilection for proximal muscles, sensory loss and areflexia and it has a relapsing or progressive course. The physiopathology is still unclear, but it is probably an autoimmune disease involving autoreactive T and B cells. CIDP is well described in association with many diseases but not with leprosy reaction wich is an immunologically mediated episode of acute inflammation that occurs in any time of leprosy disease, including after the multidrug therapy. Here we presented a patient who developed CIDP in the context of a leprosy reversal reaction, years after the end of leprosy treatment who recovered for both conditions after corticosteroid therapy. This patient's CIDP presentation could be attributed to cell injury caused by type 1 reaction that exposed the neural antigens and incited an autoimmune reaction.

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“…It is well known that in treated leprosy patients, some persistent mycobacteria remain in latent form 1,5,8,10 . Whether this fact can be related to late reactions is still a controversial issue 3 .…”

Section: Discussionmentioning

confidence: 99%

Early diagnosis of relapse in borderline leprosy: two case reports

Brandão

Lima

Piñeiro-Maceira

et al. 2011

Rev. Inst. Med. trop. S. Paulo

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SUMMARYTwo cases of relapse in borderline leprosy were reported. Despite the late-reversal, reaction-like feature, the suspicion of relapse in both was based on persistent and slow-developing skin lesions and an absence of acute neuritis or reaction during one year of follow-up. The authors have considered this possible occurrence in lepromatous borderline-treated patients after their immune cellular restoration and defend that not all Type 1 reactions would be an inflammatory answer to persistent Mycobacterium leprae, but that they could be. Therefore, a relapse diagnosis could be applied and it is more advisable, as one year of Multi-Drug Therapy (MDT) is less dangerous and more efficient for these cases than one year of corticosteroids.

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On the spectrum of leprosy neuropathies: Multifocal inflammatory neuropathy heralding leprosy relapse

Cited by 4 publications

References 7 publications

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy

Progressive neuropathy in patients with lepromatous leprosy after multidrug therapy

Chronic Inflammatory Demyelinating Polyneuropathy In A Patient With A Leprosy Reversal Reaction: A Case Report

Early diagnosis of relapse in borderline leprosy: two case reports

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