01609nas a2200241   4500000000100000008004100001260001300042653002100055653001100076653000900087653001700096653001600113653002100129653002200150653002700172100001100199700001500210245004800225300001000273490000700283520106300290022001401353       2013                            d  c2013 Feb10aElectromyography10aHumans10aMale10aMedian Nerve10aMiddle Aged10aMononeuropathies10aNeural Conduction10aNeurologic Examination1 aHuda S1 aKrishnan A00aAn unusual cause of mononeuritis multiplex.  a39-410 v133 a<p>A middle-aged man of South Asian decent presented with a 4-month history of bilateral sensory disturbance affecting the median nerve distribution and dorsum of both feet. Neurological examination was otherwise normal. A patchy absence of sensory responses was noted on nerve conduction studies and electromyogram (NCS/EMG). Over the next 3 months sensory symptoms progressed to involve median, radial, ulnar, sural and peroneal nerves bilaterally. Repeat NCS/EMG confirmed a mononeuritis multiplex predominantly involving the sensory fascicles. Areas of hypopigmentation, a right-lower motor facial weakness and ophthalmic branch trigeminal nerve involvement were noted on examination. Punch skin biopsy as well as sural nerve biopsy demonstrated chronic granulomatous inflammation without evidence of Mycobacterium. A slit skin smear test demonstrated Mycobacterium leprae consistent with a diagnosis of primary neuritic leprosy. In the appropriate clinical context, leprosy should be included in the differential diagnosis of mononeuritis multiplex.</p>  a1474-7766