Demyelination as presentation in leprosy neuropathy
Objective: We describe three cases of patients from National Referral Center for leprosy treatment in Brazil, that were newly diagnosed with leprosy and were neurologically with a paucity of symptoms but with extent neurophysiologic nerve damage.
Background: Neural damage in leprosy can occur in any period on the course of the disease. It can be unrecognized until extensive nerve damage is already installed.
Design/Methods: Case report
Results: The three patients had sensory impairment at neurological examination but had no motor function impairment. All patients had positive skin smears and were diagnosed with lepromatous leprosy (LL). They began the multidrug therapy (MDT) for multibacillary leprosy and all presented higher seric concentrations of the cytokines interleukin (IL)-15, Tumour Necrosis Factor (TNF) and IL-10 when compared to normal volunteers. The three patients were submitted to Nerve Conduction Study (NCS) in their first months of MDT. They did’nt present any leprosy reaction until that time. All patients showed impairment of sensory nerve study (sNCS) with an asymmetrical pattern. Most of nerve studied has no response and few had axonal and demyelinating lesion. In the motor NCS there was a predominance of demyelinating lesion patterns associated with secondary axonal degeneration.
Conclusions: Silent neuritis should be recognized early to prevent leprosy disability, and it is based on clinical parameters. NCS is a sensitive tool to study leprous nerve damage. It can provide information concerning clinically undetected alterations. Most recent studies have conveyed the idea that early electrophysiological changes of leprosy patients are discordant from the initiation and type of the predominant injury, which is considered by most authors as demyelination. If treatment with corticosteroids is indicated to prevent further disability in these cases is a question that remains to be answered. A better comprehension about the physiopathology of leprosy neuropathy and its follow up is necessary to better clarify this question.