03318nas a2200433   4500000000100000008004100001260004600042653001400088653001700102653002100119100001300140700001700153700001900170700001300189700001300202700001300215700001900228700001200247700001300259700001500272700001000287700001500297700001200312700001400324700001700338700001300355700001200368700001500380700001800395700001300413700001600426700001400442245010600456856007900562300000900641490000700650520221300657022001402870       2026                            d  c04/2026bPublic Library of Science (PLoS)10aDiagnosis10aTherapeutics10aNeuritic leprosy1 aSarkar S1 aMiraclin T A1 aJayachandran R1 aJasper A1 aEapen RA1 aMathew L1 aSathishkumar D1 aPeter D1 aGeorge L1 aVanjare HA1 aBal D1 aHemalatha 1 aNair AV1 aAhmed SAI1 aPrabhakar AT1 aMathew V1 aAaron S1 aPulimood S1 aSathyakumar R1 aChacko G1 aSivadasan A1 aVinetz JM00aDiagnosis and therapeutic outcomes of biopsy-confirmed Pure Neuritic Leprosy: A two-decade experience  uhttps://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014212  a1-120 v203 a<p><strong>Background</strong></p>

<p>Pure neuritic leprosy (PNL) is a distinct form of leprosy characterized by peripheral nerve involvement without skin lesions. Diagnosis is often delayed, and ‘silent neuritis’ contributes to progressive and irreversible nerve damage. Despite appropriate therapy, many patients develop long-term disability. This study describes the clinical profile, diagnostic patterns, therapeutic outcomes, and predictors of disability in biopsy-confirmed PNL.</p>

<p><strong>Methods</strong></p>

<p>We conducted a retrospective observational cohort study at a tertiary referral centre in South India, enrolling biopsy-confirmed PNL cases from January 2003 to May 2023. Demographic, clinical, electrophysiological, and histopathological data were collected. The primary outcome was the proportion of patients with high disability at follow-up (WHO grade 2). Predictors of disability were identified using multivariate analysis.</p>

<p><strong>Results</strong></p>

<p>Ninety-five patients were included (mean age 43.02 years (SD 15.32); 77% male). Over half (55%) presented 1–5 years after symptom onset. Sensory deficits were most common (80%), followed by foot drop (51%), ulnar claw (38%), and trophic ulcers (25%). Electrophysiology revealed mononeuritis multiplex in 52.6% and axonal polyneuropathy in 22.2%. Nerve biopsy showed borderline tuberculoid pathology in 78% and borderline lepromatous in 15.7%. Notably, 6 patients with mononeuropathy had lepromatous pathology. All patients received multidrug therapy; 41 experienced lepra reactions. Higher severity at treatment initiation was significantly associated with persistent disability.<strong> </strong></p>

<p><strong>Conclusions</strong></p>

<p>PNL often presents late, with many patients already experiencing nerve damage. A substantial subset of clinically mononeuritis patients demonstrated lepromatous pathology, emphasizing the need for nerve biopsy in all suspected cases. Early detection and timely treatment may reduce disability burden. These findings highlight critical gaps in current diagnostic strategies and underscore the importance of aggressive early intervention in PNL.</p>
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