02641nas a2200241   4500000000100000008004100001260001200042100001400054700001300068700001400081700001200095700001300107700001200120700001400132700001200146700001400158245011000172856007800282300001300360490000700373520200500380022001402385       2022                            d  c01/20221 aPitta IJR1 aHacker M1 aAndrade L1 aSpitz C1 aVital RT1 aSales A1 aAntunes S1 aSarno E1 aJardim MR00aFollow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro-Brazil.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8752023/pdf/pntd.0010070.pdf  ae00100700 v163 a<p><strong>INTRODUCTION: </strong>Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature.</p>

<p><strong>OBJECTIVE: </strong>This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT).</p>

<p><strong>METHODS: </strong>Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS.</p>

<p><strong>RESULTS: </strong>Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT.</p>

<p><strong>DISCUSSION: </strong>The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.</p>
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