Background
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.
Case presentation
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.
Results
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.
Conclusion
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.
BT - Leprosy Review DA - 09/2026 DO - 10.47276/lr.97.3.2026043 IS - 3 LA - ENG M3 - Article N2 -Background
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.
Case presentation
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.
Results
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.
Conclusion
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.
PB - Lepra PY - 2026 SP - 1 EP - 7 T2 - Leprosy Review TI - The enigma of the ulnar claw in a child: an unusual necrotizing granuloma masquerading as a tumor UR - https://leprosyreview.org/admin/public/api/lepra/website/getDownload/6a992675afaac12795446554 VL - 97 SN - 2162-8807 ER -