Pure Neuritic Leprosy : A Series of Three Cases

Over the years, there has been significant decreasing trend in the prevalence of leprosy in India. Although the prevalence of leprosy in India is on a steady fall, the new case detection rate (NCDR) is not showing a parallel decline. The Leprosy Case Detection Campaign (LCDC), 2018 identified 363 hidden cases of leprosy in Mumbai. Polyneuritic Leprosy (PNL) has been considered relatively uncommon and reported only in 1.5% to 8.1% of leprosy patients. However, recent Indian studies have shown a greater incidence of PNL amongst all the leprosy cases diagnosed ranging from 5.5% to 18%. PNL does not present with skin lesions, hence many of them are likely to remain underdiagnosed for a long time. The patients usually visit Medicine and Neurology clinics for the symptoms and may be misinterpreted as neuropathies. The clinical suspicion of PNL is made in case of thickened peripheral nerve trunk associated with tenderness or sensory impairment and lack of skin lesions. Nerve biopsy is the gold standard for diagnosis of PNL followed by classification of cases as given by Indian Association of Leprologists (IAP 1982). We present here three cases of PNL diagnosed on nerve biopsy and discuss them in the context of review of literature.