British Leprosy Relief Association
Clinical, electroneuromyographic and morphological studies of pure neural leprosy in a Brazilian referral centre
Da Costa NériJosé Augustoa
AntunesSérgio Luiz Gomesa
aLaboratory of Leprosy, Department of Tropical Medicine, Department of Ultrastructure and Cell Biology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil and Department of Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Correspondence to: S. L. Gomes Antunes, Fundação Instituto Oswaldo Cruz, Laboratório de Hanseníase, Av. Brasil 4365, Manguinhos, CEP 21045.900, Rio de Janeiro, Brazil (e-mail: firstname.lastname@example.org)
Nineteen patients with pure neural leprosy were analysed with clinical examination, electroneuromyography and histopathology of nerve biopsies. Clinical examination showed sensory loss (78.9%), paresis (78.9%), nerve enlargement (68.4%) and nerve pain (42.1%). Electroneuromyographic study revealed an axonal pattern in 18 patients (94.7%) and a demyelinating pattern in one (0.5%). Mononeuropathy multiplex was the most frequent presentation (78.9%), followed by mononeuropathy simplex (10.5%) and polyneuropathy (10.5%). The histopathological study showed the presence of inflammatory infiltrate composed of epithelioid granuloma (42.1%), mononuclear infiltrate (36.8%) or macrophages positive for bacilli (21%). Fibrosis was present in 78.9% of the biopsies. Examination of semithin sections revealed, besides inflammatory infiltrate, myelinated fibre loss (94.7%), remyelination (42%), axonal degeneration (10%) as well as regeneration (31.5%). Based on these results, the pathogenesis of leprosy neuropathy in this group of patients is briefly discussed.