Journal List > Korean J Clin Neurophysiol > v.15(1) > 1084113

TOOLS
Yoon, Jo, Yuk, Shin, and Kim: Leprous Neuropathy Associated with Predominant Proprioceptive Sensory Loss
Case Report

Korean J Community Nutr 2013;15(1):19-23.

Published online: 19 January 2013

DOI: https://doi.org/10.14253/kjcn.2013.15.1.19

Leprous Neuropathy Associated with Predominant Proprioceptive Sensory Loss

Tae-Kwan Yoon1, Hee-Young Jo2, Ji-Won Yuk2, Jin-Hong Shin2, 3, Dae-Seong Kim1, 2, 3

1Pusan National University School of Medicine, Busan, Korea

2Department of Neurology, Pusan National University Yangsan Hospital, Busan, Korea

3Reseach Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Korea

Address for correspondence; Dae-Seong Kim Department of Neurology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea Tel: +82-55-360-2450 Fax: +82-55-360-2152 E-mail: dskim@pusan.ac.kr

* This work was supported by a 2-Year Research Grant of Pusan National University.

Received 21 January 20131 June 2013       Accepted 4 June 2013

Copyright © 2013 Journal of the Korean Society of Community Nutrition

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Some patients with leprosy may present with atypical features, such as isolated peripheral neuropathy without skin lesions, or marked proprioceptive dysfunction. We report a 56-year-old female who presented with predominant proprioceptive loss without skin lesion, but was finally confirmed as leprous neuropathy by sural nerve biopsy. It is postulated that large myelinated fibers were affected by chronic immunological reactions triggered by inactive bacterial particles, producing a peripheral neuropathy presenting as predominant proprioceptive sensory loss without typical skin lesions.

Keywords: Leprosy, Proprioception, Peripheral neuropathy

REFERENCES

1.Ooi WW., Srinivasan J. Leprosy and the peripheral nervous system: basic and clinical aspects. Muscle Nerve. 2004. 30:393–409.
crossref
2.WHO. Global leprosy situation, 2010. Wkly Epidemiol Rec. 2010. 85:337.
3.Agrawal A., Pandit L., Dalal M., Shetty JP. Neurological manifestations of Hansen’s disease and their management. Clin Neurol Neurosurg. 2005. 107:445–454.
crossref
4.Skacel M., Antunes SL., Rodrigues MM., Nery JA., Valentim VD., Morais RP, et al. The diagnosis of leprosy among patients with symptoms of peripheral neuropathy without cutaneous lesions: a follow-up study. Arq Neuropsiquiatr. 2000. 58:800–807.
crossref
5.Pandya SS., Bhakti WS. Severe pan-sensory neuropathy in leprosy. Int J Lepr Other Mycobact Dis. 1994. 62:24–31.
6.van Brakel WH., Nicholls PG., Das L., Barkataki P., Suneetha SK., Jadhav RS, et al. The INFIR Cohort Study: Investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy, Methods and baseline results of a cohort of multibacillary leprosy patients in north India. Lepr Rev. 2005. 76:14–34.
crossref
7.Khadilkar SV., Benny R., Kasegaonkar PS. Proprioceptive loss in leprous neuropathy: a study of 19 patients. Neurol India. 2008. 56:450–455.
crossref
8.Rosenberg NR., Faber WR., Vermeulen M. Unexplained delayed nerve impairment in leprosy after treatment. Lepr Rev. 2003. 74:357–365.
crossref
9.Ha YM. Relapse of Leprosy. Korean Lepr Bull. 1994. 27:27–29.
10.THELEP: Persisting Mycobacterium leprae among THELEP trial patients in Bamako and Chingleput. Subcommittee on Clinical Trials of the Chemotherapy of Leprosy (THELEP) Scientific Working Group of the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. Lepr Rev. 1987. 58:325–337.

Figure 1.
Sural nerve biopsy findings of the patient. (A) Almost complete loss of myelinated nerve fibers was observed with thickening and hypertrophy of epineurial sheath (H&E stain ×100). (B) On longitudinal sections, perivascular inflammatory infiltrates were prominent (Modified Gomori-trichrome stain ×100). (C) A non-caseating granuloma with giant cells are seen (H&E stain ×400). (D) On Fite stain, no acid-fast bacilli were observed (Fite stain, ×100). The black bars represent 100 μm.
kjcn-15-19f1.tif
Table 1.
Results of motor nerve conduction studies
Stimulation site Latency (ms) Amplitude (mV) Velocity (m/s) Stimulation site Latency (ms) Amplitude (mV) Velocity (m/s)
Right median nerve (recorded from abductor pollicis brevis muscle) Left median nerve (recorded from abductor pollicis brevis muscle)
Wrist 3.3 17.0 - Wrist 3.3 13.9 -
Elbow 7.0 16.2 59.5 Elbow 7.1 13.5 57.9
Axilla 8.4 15.7 85.7 Axilla 9.0 13.5 63.2
F-response 25.0 F-response 25.5
Right ulnar nerve (recorded from abductor digiti minimi muscle) Left ulnar nerve (recorded from abductor digiti minimi muscle)
Wrist 2.4 12.2 - Wrist 2.4 15.7 -
Below elbow 5.5 11.1 64.5 Below elbow 4.9 15.4 74.0
Above elbow 7.2 11.0 58.8 Above elbow 6.6 15.6 58.8
Axilla 8.9 9.8 64.7 Axilla 8.3 15.1 64.7
F-response 27.4 F-response 25.9
Right peroneal nerve (recorded from extensor digitorum brevis muscle) Left peroneal nerve (recorded from extensor digitorum brevis muscle)
Ankle 2.9 3.8 - Ankle 3.1 10.0 -
Fibular head 10.1 3.3 41.7 Fibular head 9.3 8.8 45.2
Poplitea fossa 11.8 3.1 55.9 Poplitea fossa 10.8 8.6 63.3
F-response No response F-response 44.4
Right posterior tibial nerve (recorded from abductor hallucis muscle) Left posterior tibial nerve (recorded from abductor hallucis muscle)
Ankle 2.7 20.9 - Ankle 3.7 18.2 -
Poplitea fossa 10.8 16.3 42.0 Poplitea fossa 11.5 14.0 43.6
F-response 48.2 F-response 49.1
H-reflex* No response H-reflex* No response

* Response was recorded from gastrocnemius muscle with the stimulation of posterior tibial nerve at popliteal fossa.

Table 2.
Results of sensory and mixed nerve conduction studies
Stimulation site Recording site Amplitude (μV) Velocity (m/s) Stimulation site Recording site Amplitude (μV) Velocity (m/s)
Right median nerve Left median nerve
Second finger Wrist No response - Second finger Wrist 1.4 40.6
Wrist Elbow 4.7 55.3 Wrist Elbow 11.1 51.3
Elbow Axilla 43.4 69.4 Elbow Axilla 45.3 71.9
Right ulnar nerve Left ulnar nerve
Fifth finger Wrist No response - Fifth finger Wrist 3.0 43.5
Wrist Elbow 6.1 56.6 Wrist Elbow 12.3 66.1
Elbow Axilla 25.6 54.8 Elbow Axilla 24.3 65.8
Right radial nerve Right radial nerve
Above wrist Fir rst web space No response - Above wrist First web space No response -
Right sural nerve Right sural nerve
Mid-calf Ankle No response - Mid-calf Ankle No response -
Right superficial peroneal nerve Left superficial peroneal nerve
Distal leg Ankle No response - Distal leg Ankle No response -
TOOLS
Similar articles