02403nas a2200325   4500000000100000008004100001260001200042653001300054653002700067653003900094653001600133100002300149700001300172700001200185700001200197700001200209700001600221700001200237700001500249700001400264700001200278700001500290700001300305245008300318856007000401300001000471490000600481520157600487022001402063       2026                            d  c06/202610aDatabase10aDifferential diagnosis10aPeripheral Nervous System Diseases10aSural Nerve1 aSiquara-de-Sousa A1 aHacker M1 aVital R1 aPitta I1 aSpitz C1 aDomingues C1 aSales A1 aChimelli L1 aAntunes S1 aSarno E1 aPinheiro R1 aJardim M00aPeripheral nerve biopsy in pure neural leprosy: a 26-year experience in Brazil  uhttps://pmc.ncbi.nlm.nih.gov/articles/PMC13348849/pdf/fcag249.pdf  a1 - 80 v83 a<p>Brazil ranks second globally in leprosy burden, with approximately 25 000 cases reported in 2022. This study aimed to analyse the 26-year experience (1997-2023) in nerve biopsies at a specialized leprosy outpatient clinic, focusing on their usefulness in diagnosing peripheral neuropathy in patients with clinical and neurophysiological features suggestive of leprosy but lacking dermatological lesions. Tissue samples were preserved in glutaraldehyde, buffered formalin and liquid nitrogen, with histopathological analysis using various staining techniques and molecular testing on frozen material. In 819 cases, 529 were diagnosed with leprosy (64.6% overall leprosy diagnosis rate), and 207 pure neural leprosy cases were confirmed. Other conditions identified included vasculitis, diabetic neuropathy and amyloidosis, while 16.5% of cases yielded inconclusive results. The predominant clinical symptoms included sensory disorders (85.7%), localized paraesthesia (70.3%) and muscle weakness (59.4%), with multiple mononeuropathies frequently observed on electroneuromyography. The most biopsied nerves were the ulnar cutaneous branch (50.6%), sural (37.2%) and superficial peroneal (6.8%). Nerve biopsy proved valuable for confirming leprosy and distinguishing differential diagnoses in complex cases, particularly when clinical findings alone were insufficient. Integrating clinical-pathological correlation optimized diagnostic accuracy, underscoring the importance of this tool in managing suspected neural leprosy and guiding treatment in challenging cases.</p>  a2632-1297