Late-onset ulnar neuritis following treatment of lepromatous leprosy infection

Abstract

Neuritis is a frequent complication of Myocobacteria leprae infection and treatment due to the variety of mechanisms through which it can occur. Not only can mycobacterial invasion into peripheral nerves directly cause damage and inflammation, but immune-mediated inflammatory episodes (termed leprosy reactions) can also manifest as neuritis at any point during infection. Treatment of leprosy reactions with thalidomide can also lead to neuritis due to an adverse drug effect. Neuritis can emerge years after initial diagnosis and treatment, although it is most frequently found at time of diagnosis or early into the treatment course. Treatment of neuritis is dependent on high-dose corticosteroid therapy as well as therapy for suspected underlying etiology. Here, we present a case of ulnar neuritis presenting in a patient with lepromatous leprosy four years after treatment of initial infection, with subsequent improvement after corticosteroid burst while maintained on thalidomide therapy.

An individual randomised efficacy trial of autologous blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in leprosy in Nepal: the TABLE trial protocol

“…Neuropathy is caused primarily by inflammatory episodes called 'reactions', which can occur in 30-50% of leprosy cases in response to live Mycobacterium leprae or residual antigens persisting for years in skin and nerve tissues after curative treatment [1,2]. Neuritis can develop and recur at any time before, during or even years after leprosy treatment [3]. The combination of loss of sensation and deformities leads to the presentation of ulcers, often with the first presentation within 4-5 years of leprosy diagnosis, and then an increased lifetime risk of recurrent ulcers, which can lead to deformity and permanent disability.…”

An individual randomised efficacy trial of autologous blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in leprosy in Nepal: the TABLE trial protocol

“…Neuropathy is caused primarily by in ammatory episodes called 'reactions', which can occur in 30-50% of leprosy cases in response to live Mycobacterium leprae or residual antigens persisting for years in skin and nerve tissues after curative treatment (1,2). Neuritis can develop and recur at any time before, during or even years after leprosy treatment (3). The combination of loss of sensation and deformities leads to the presentation of ulcers, often with the rst presentation within 4-5 years of leprosy diagnosis, and then an increased lifetime risk of recurrent ulcers, which can lead to deformity and permanent disability.…”

Leprosy Reactions and Neuropathic Pain in Pure Neural Leprosy in a Reference Center in Rio de Janeiro – Brazil

“…Leprosy reactions are complications that can occur before, during, or after the MDT and are considered a major cause of nerve damage (3)(4)(5)(6). They represent acute changes in the host immune response to Mycobacterium leprae and are thought to occur in 30-50% of all leprosy patients (2,3).…”

“…Type 1 reactions usually have the development of an inflammatory response in the skin or nerves and are thought to occur in borderline leprosy patients, whose immunological status is unstable. Type 2 reactions are known to cause painful erythematous subcutaneous nodules as well as systemic symptoms, occur mainly in lepromatous leprosy, and are thought to be primarily humoral mediated (5,6).…”

“…In the clinical evaluation, neuritis is an inflammatory process that affects the nerves and causes nerve function impairment associated with pain and tenderness along the nerve (3,5,6). It can be found in both type 1 and type 2 reactions and may also be the sole manifestation of a leprosy reaction, as an isolated neuritis without skin lesions (2,4,(7)(8)(9).…”