02286nas a2200229   4500000000100000008004100001260001900042653001600061653005600077653002600133100001400159700001500173700001700188700001400205700001300219245010200232856009800334300001000432490000700442520159300449022001402042       2026                            d  c09/2026bLepra10aUlnar nerve10aSegmental necrotizing granulomatous neuritis (SNGN)10anecrotizing granuloma1 aMishra JK1 aValsalan A1 aAnand Sahu S1 aEadelli D1 aRahmi JJ00aThe enigma of the ulnar claw in a child: an unusual necrotizing granuloma masquerading as a tumor  uhttps://leprosyreview.org/admin/public/api/lepra/website/getDownload/6a992675afaac12795446554  a1 - 70 v973 a<p><strong>Background</strong></p>

<p>Granulomatous lesions of peripheral nerves are rare and usually linked to tuberculosis or Hansen’s disease. Isolated necrotising granulomatous involvement of the ulnar nerve without systemic features is exceptionally uncommon and diagnostically challenging.</p>

<p><strong>Case presentation</strong></p>

<p>A 9-year-old boy presented with a 5-month history of left-sided medial arm swelling and 3-month progressive weakness of the left little and ring fingers. Examination showed a 4 × 3 cm firm swelling with ulnar claw deformity, hypothenar wasting, and sensory loss in the ulnar distribution; Wartenberg’s, Froment’s, and Duchenne’s signs were positive. MRI suggested an ulnar nerve lesion. Intraoperatively, an 11 cm diseased segment with cystic nodular thickening was identified and excised, followed by reconstruction with sural nerve grafts and later distal nerve transfer.</p>

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

<p>Histopathology showed necrotising granulomatous inflammation with epithelioid histiocytes and multinucleated giant cells; AFB, PAS, and other investigations were negative. At 2-year follow-up, the patient demonstrated improved hand cascade, intrinsic muscle recovery (M4/5), and partial sensory return.</p>

<p><strong>Conclusion</strong></p>

<p>Necrotising granulomatous lesions of the ulnar nerve are rare and may mimic nerve sheath tumours. Early surgical excision with nerve reconstruction and distal nerve transfer can provide satisfactory functional recovery in such unusual presentations.</p>
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