Clinical and diagnostic aspects of the primarily neural leprosy

José Antonio Garbino; Somei Ura; Andréa de Faria Fernandes Belone; Lúcia Helena Soares Camargo Marciano; Raul Negrão Fleury

doi:10.47878/hi.2004.v29.36384

Autores/as

José Antonio Garbino This study is part of the research on peripheric neuropathles of the Rehabilitation Division, Lauro de Souza Lima Institute
Somei Ura Medical Doctor, specialist in Rehabilitation Medicine and Clinical Neurophislology, Lauro de Souza Lima Institute. Post-graduate student in the Infection and Public Health Program of the Coordenaria dos Institutos de Pesquisa, Secretaria de Estado da Saúde de São Paulo.
Andréa de Faria Fernandes Belone Medical Doctor, Dermatologist and Researcher, Lauro de Souza Lima Institute.
Lúcia Helena Soares Camargo Marciano Biologist and Researcher, Lauro de Souza Lima Institute. Doctor in Pathology.
Raul Negrão Fleury Occupational Therapist and Researcher, Lauro de Souza Lima Institute. Master in Rehabilitation.

DOI:

https://doi.org/10.47878/hi.2004.v29.36384

Palabras clave:

leprosy, neuropathy, nerve biopsy

Resumen

A total of 33 patients, 28 males and five females, from nine to 87 years of age, wi th suspec ted leprosy associated peripheral neuropathy, without detectable skin lesion or positive skin bacilloscopy, were studied during the period of 1994 to 2004. Patients were s u bmi t t e d t o d e rma t o l o g i c a l a n d n e u r o l o g i c a l examination, electrophysiologic tests, Mitsuda reaction and nerve biopsy. Samples for histopathological exams
were stained with hematoxillin-eosin, Faraco-Fite and immunohistochemistry with anti -BCG antibodies. Among patients with suspected leprosy, the clinical presentation of polyneuropathy occurred in 17 (51.51%) patients while 13 (39.39%) presented mononeuropathy mu l t ip l ex an d 3 ( 9 .1%) mo n o n e ur op a t hy . T h e hematoxillin-eosin and Faraco-Fite stainings confirmed the leprosy diagnosis in 10 (30.30%) patients. Three patients presented a borderline pattern, two tuberculoidpattern and no characteristic histological pattern was observed in the remaining five patients. The final classification depended on the clinical-histological correlation. Immunohistochemistry increased the diagnosis to 11 (33.33%) cases. Among the remaining 22 patients, three patients had leprosy confirmed increasing the diagnosis to 14 (42.43%) cases. One was clinically
understood as a primarily neural leprosy, probably tuberculoid form of the childhood. From the remaining patients, 19 (57.57%) were excluded during the follow-up. The primarily neural leprosy (PNL) is an unusual leprosy presentation and a complex form to diagnose. The clinical follow-up accompanied by the improvement of histopathological examination of the nerve may add more accuracy to the investigation of the suspected leprosy neuropathies.

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Citas

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