01858nas a2200241   4500000000100000008004100001260001000042653001200052653001500064653002200079100002200101700001400123700001400137700001000151700001400161700001200175245005500187856009800242300000800340490000700348520124700355022001401602       2024                            d  bLepra10aLeprosy10aNeuropathy10aLeprosy reactions1 aUmakant Naphade P1 aNirhale S1 aRohatgi S1 aRao P1 aHatekar K1 aMirza S00aLeprosy presenting as acute sensory polyneuropathy  uhttps://leprosyreview.org/admin/public/api/lepra/website/getDownload/66ab2564afaac108cf3cc6e5  a1-50 v953 a<p>A middle-aged female had tingling in all four limbs for ten days. On examination she had a sensory polyneuropathy with bilateral tender, non-thickened ulnar nerves, with normal power. There were no skin lesions. Nerve conduction studies showed a sensory-motor, mixed axonal and demyelinating polyneuropathy. Other laboratory workup was negative. Differentials like Guillain Barre syndrome and vasculitic polyneuropathy were ruled out due to incongruent clinical features.</p>

<p>Because the patient lived in an endemic area for leprosy and had tender ulnar nerves, a slit skin smear study was done, which was positive. Common neurological manifestations of leprosy are mononeuropathy and mononeuritis multiplex. Uncommonly, leprosy presents as polyneuropathy – actually, a mononeuritis multiplex summation. Lepra reactions often present with neuritis and skin manifestations. Neuritis can occur without dermatological manifestations in 5–6% of lepra reactions. This case has acute polyneuropathy probably as manifestation of a lepra reaction without any skin features. In endemic regions, consider leprosy in any case of neuropathy, even if there are no skin lesions, and especialy if the findings do not suggest other causes.</p>
  a2162-8807