Giant nerve abscesses in leprosy

Abstract

Two leprosy patients with neuritis caused by giant abscesses involving almost the entire ulnar nerve are described. One patient, who also had skin lesions, was diagnosed histopathologically as having borderline tuberculoid leprosy both on skin and nerve biopsy, and the other, with only nerve involvement, belonged to the pure neuritic group. The lepromin test was strongly positive (with a vesicular reaction in one patient) and lymphocyte transformation to Mycobacterium leprae antigen was raised. These lesions can be easily mistaken for a peripheral nerve tumour in places where leprosy is uncommon. A brief account of the management of nerve abscess in leprosy is given.

The diagnosis of leprosy among patients with symptoms of peripheral neuropathy without cutaneous lesions: a follow-up study

“…As a consequence, there is a progressive impairment of unmyelinated and myelinated neural fibers 6,7 followed by a replacement of the peripheral nerve parenchyma for fibrous tissue 8 . Necrotic caseation may also occur in tuberculoid granulomas of the nerves resulting in its complete destruction by abscesses 9 . The inflammatory infiltrate of the nerves may be distinct from the ones in the cutaneous lesions, being multibacillary in the nerves and paucibacillary in the skin 10,11 .…”

Multiple giant nerve abscesses presenting like lipoma in a treated patient of Hansen’s disease

“…They are usually found in patients in the paucibacillary spectrum of the disease 2 . Very few cases have been reported, particularly from the endemic areas 3 …”

“…2 Very few cases have been reported, particularly from the endemic areas. 3 The bacterial dissemination may be hematogenous or by contiguous spread from skin. The usual habitat in the nerve is the Schwann cell, but occasionally the ensheathed axon becomes involved.…”

Sporotrichoid Tuberculoid Leprosy

“…Management of nerve abscess is giving (i) complete rest to the a¡ected part, (ii) anti-in£ammatory drugs and corticosteroids, and (iii) anti-leprosy therapy. When the abscess is large, surgical intervention may be required (2). Treatment of palsies requires expert care in a centre with adequate facilities.…”