Publication

Abstract : Background: Pure neural leprosy (PNL) continues to be common in India. This form of disease is least studied and very little information exists in literature. We analyzed the demographic profile and clinical aspects of PNL at our center. Methods: Retrospective analysis of confirmed PNL registered in leprosy clinic in our institute between January 2003 and July 2007 was undertaken. Demographic and clinical profile including onset of disease and presenting complaints, pattern of nerve involvement, presence of nerve abscess and deformities were analyzed. Investigations such as slit-skin smear (SSS), skin biopsy, electrophysiological study (EPS) and nerve biopsy were done. Results: Of 1975 leprosy cases seen during this period, 188 (9.5%) had PNL which included 160 (85%) males and 28 (15%) females, with 121 (64.36%) cases within 20–40 years. Presenting symptoms were paresthesia, pain, sensory loss and motor weakness. Majority of the patients i.e 119 (63.3%) had 2–5 nerve involvement while 49 (26%) had >5 nerve involvement. Ulnar nerve was most commonly involved in 130 (69.14%) cases followed by common peroneal in 91 (48.4%). Deformities included claw hand in 50 (26.6%), foot drop in 21 (11.17%) facial palsy in 2 and wrist drop in one patient only. Skin biopsies were non-specific in all cases. Nerve biopsy (n=17) revealed features ranging from normal, to infiltration with epithelioid cell granulomas, fibrosis, lymphohistiocytic infiltrate and AFB positive foamy histiocytes. EPS showed features of sensory/motor axonal neuropathy, demyelination, denervation with poor to moderate renervation or decreased sensory nerve action potential. Conclusions: PNL is a distinct type of leprosy in India. Men are more commonly affected and ulnar nerve involvement is the most common manifestation. Sensory complaints are early and more common. Early diagnosis and treatment is helpful in preventing sequel due to nerve damage.