Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: a case report

Jain, Suman; Visser, Leo H.; Yerasu, Muralidhar; Raju, Ravikiran M.; Meena, Anju; Lokesh, B.; Suneetha, Sujai

doi:10.47276/lr.84.2.161

Cited by 14 publications

(3 citation statements)

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“…The authors concluded that ultrasonography exhibits more nerve damage than a clinical examination. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen’s Disease

Rai,

Singh,

Indal

et al. 2024

Indian Dermatology Online Journal

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Introduction: Hansen’s disease (HD) is a major public health problem in developing countries. It causes peripheral neuropathy, and if left untreated, it leads to deformities. It is important to diagnose such cases early, and prompt treatment should be given to patients to preserve nerve function. Materials and Methods: A total of 40 patients with HD who were already on multi-drug therapy (MDT) or treatment-naive were included in this study. These were clinically diagnosed cases of HD as per the Ridley–Jopling classification, and these patients were subjected to high-resolution ultrasonography (HRUS). A total of 19 controls were also included. The patients were clinically evaluated, and HRUS of bilateral ulnar nerves (UNs) was performed in all cases and controls. The other peripheral nerves, if clinically thickened, were evaluated using HRUS. Results: The cross-sectional area (CSA) of the UN in cases was significantly thickened as compared to controls. There was no difference in the CSA of patients on MDT as compared to treatment naïve patients. In two patients with pure neuritic HD, the clinical examination missed the bilateral nerve enlargement, and only unilateral nerve thickening was clinically appreciated. However, bilateral thickening was detected on HRUS. Conclusion: HRUS is a non-invasive and sensitive diagnostic tool that gives significant information on nerve structure and morphology. HRUS adds a new dimension to diagnosing HD, particularly the pure neuritic type, with the assessment of early nerve damage, which can prevent disabilities. HRUS is an objective diagnostic tool that can complement the clinical examination.

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“…The authors concluded that ultrasonography exhibits more nerve damage than a clinical examination. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen’s Disease

Rai,

Singh,

Indal

et al. 2024

Indian Dermatology Online Journal

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“…Thickened epineurium noted in the ulnar nerve, which is the most commonly affected nerve, and altered echotexture of the nerves with increased epineural blood flow on color Doppler may provide clues toward the diagnosis of leprosy. 44,45 CONCLUSION On most occasions, there are multiple thickened peripheral/ cutaneous nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are usually not as much widespread. It is important to select the nerve which has deficits in relation to its distribution.…”

Section: Discussionmentioning

confidence: 99%

Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method

Vengalil

Lavania²,

Singh³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Identification of Mycobacterium leprae DNA by polymerase chain reaction (PCR) is a reliable and an affordable method to confirm leprosy. DNA from 87 nerve samples (61 from paraffin blocks and 26 fresh samples) was extracted. Mycobacterium leprae DNA was amplified by PCR from 80/87 (92%) specimens. Patients were seen over a period of 11 years (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), and leprosy was diagnosed based on clinical and characteristic histopathology findings. The clinical diagnostic possibilities were as follows: leprous neuropathy in 73/80 (91.3%), mononeuritis multiplex of unknown etiology in four (5.0%), vasculitic neuropathy in two (2.5%), and distal symmetric sensory motor neuropathy in one (1.3%). The biopsied nerves were as follows: superficial radial = 34 (42.6%), dorsal cutaneous branch of ulnar = 19 (23.8%), sural = 18 (22.5%), and superficial peroneal = 9 (11.3%), and corresponding neurological deficits were recorded in 77 (96.3%) cases. The histopathological diagnoses in total group were as follows: (borderline tuberculoid (BT) = 52, tuberculoid (TT) = 8, borderline lepromatous (BL) = 8, borderline borderline (BB) = 3, nonspecific inflammation = 3, healed/ fibrosed = 4, and axonopathy = 2). Acid fast bacilli (AFB) was demonstrated in 11 (13.7%) samples. For comparison, 31 clinically and histopathologically defined non-leprous disease control nerves (inherited neuropathy = 20, vasculitis = 8, and nutritional neuropathy = 3) subjected to PCR were negative for M. leprae DNA. In most instances, there are multiple thickened peripheral nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are not as widespread. The current findings emphasize the importance of selecting the most appropriate nerve for biopsy to obtain a positive PCR result. We infer that clinical, histopathological, and PCR tests complement each other to help achieve a definitive diagnosis of leprosy particularly in pure neuritic leprosy and in leprous neuropathy with negative skin smears/biopsy.

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“…[ 15 ] Ultrasonography has become a useful diagnostic tool to confirm PNL, circumventing the use of the invasive and potentially damaging tool of nerve biopsy for its definitive diagnosis. [ 16 ] The CSA of each individual nerve should be taken into consideration rather than an average CSA of all nerves since patients can present with thickening of only one or two nerves with all other nerves being normal in size. HRUS can help in the differentiation of leprosy from other neuropathies like ulnar nerve entrapment (UNE) where the nerve enlargement is found to be at the sulcus or just above the elbow, while in leprosy, it is more proximal, 3–4 cm above the elbow.…”

Section: Key Applications Of Hrus In Leprosymentioning

confidence: 99%

High-Resolution Ultrasonography in Leprosy

Suneetha

Rao²

2021

Indian Dermatology Online Journal

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Use of high resolution ultrasonography as an additional tool in the diagnosis of primary neuritic leprosy: a case report

Cited by 14 publications

References 0 publications

High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen’s Disease

High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen’s Disease

Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method

High-Resolution Ultrasonography in Leprosy

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