01581nas a2200241   4500000000100000008004100001653000800042653001200050653002700062100001500089700001500104700001800119700001500137700001400152700001600166700001400182700001200196700001200208245004400220490001300264520104800277022001401325       2016                            d10aHIV10aleprosy10aMononeuritis multiplex1 aGaltrey CM1 aModarres H1 aJaunmuktane Z1 aBrandner S1 aRossor AM1 aLockwood DN1 aReilly MM1 aManji H1 aSchon F00aLeprosy in a patient infected with HIV.0 v179430813 a<p>A 60-year-old Nigerian man, who had lived in Europe for 30 years but had returned home frequently, presented with right frontalis muscle weakness and right ulnar nerve palsy, without skin lesions. Neurophysiology showed a generalised neuropathy with demyelinating features. Blood tests were positive for HIV, with a normal CD4 count. There was nerve thickening both clinically and on MRI. Nerve biopsy showed chronic endoneuritis and perineuritis (indicating leprosy) without visible mycobacteria. His neuropathy continued to deteriorate (lepra reaction) before starting treatment with WHO multidrug therapy, highly active antiretroviral therapy and corticosteroids. There are 10 new cases of leprosy diagnosed annually in the UK. Coinfection with HIV is rare but paradoxically does not usually adversely affect the outcome of leprosy or change treatment. However, permanent nerve damage in leprosy is common despite optimal therapy. Leprosy should be considered in patients from endemic areas who present with mononeuritis multiplex.</p>
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