Leprous ganglionitis and myelitis

Rice, Claire M; Oware, Agyepong; Klepsch, Sabine; Wright, Beth; Bhatt, Nidhi; Renowden, Shelley; Jenkins, Megan; Rajan, Suchitra; Bovill, Begoña

doi:10.1212/nxi.0000000000000236

Cited by 11 publications

(11 citation statements)

References 6 publications

(7 reference statements)

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“…Although infiltration by M. leprae bacilli was not pathologically confirmed in cervical cord lesions, the specimen from the frontal cystic lesion demonstrated abundant scattered foamy macrophages with fragmented bacilli on Fite acid-fast stain, and PCR showed positive bands with sequence homology to the M. leprae genome. [5][6][7] Our Case 1 had relapsing leprosy with severe facial weakness and demonstrated pontine lesions. We believe that this is the first report to document involvement of the facial nuclei along with enhancing facial nerves by MRI in a living patient with leprosy.…”

Section: Discussionmentioning

confidence: 79%

“…There are two earlier case reports of MRI findings with spinal cord abnormalities suspected to be secondary to leprosy without definitive pathological confirmation. 5,6 Khadilkar et al 5 reported a 20-year-old Indian man with a hypo-aesthetic patch and ulnar neuropathy. Superficial radial nerve biopsy showed lepra bacilli.…”

Section: Discussionmentioning

confidence: 99%

“…Cervical spine MRI revealed focal T1W hyperintense central signal within a larger area of T2W hyperintensity at the C5-C6 level along with smooth thickening of ventral and dorsal roots and enlarged enhancing dorsal root ganglia. 5 Rice et al 6 reported a 27-year-old Brazilian woman with skin lesions, progressive pain, tingling, numbness, and weakness of the left upper limb. Magnetic resonance imaging showed expansion of the cervical cord with an intramedullary, enhancing area of high signal at C5-C7, and the corresponding dorsal root ganglia on the same side were swollen and demonstrated high T2 signal compatible with ganglionitis.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging showed expansion of the cervical cord with an intramedullary, enhancing area of high signal at C5-C7, and the corresponding dorsal root ganglia on the same side were swollen and demonstrated high T2 signal compatible with ganglionitis. 6 Yamada 14 identified para-rosaniline-positive material in the brain and spinal cord more in patients with tuberculoid leprosy than lepromatous leprosy. This is in concordance with the majority our patients (6/8) with CNS lesions having features of BT-type leprosy in their peripheral nerves.…”

Section: Discussionmentioning

confidence: 99%

“…4 Skin and peripheral nerve affliction in leprosy has been extensively studied and published, but reports on involvement of the central nervous system (CNS) and proximal nerves are extremely rare. [5][6][7] Clinical and histopathological findings on skin and nerve tissue are usually sufficient to diagnose leprosy. However, polymerase chain reaction (PCR) is reported to be the most sensitive and specific test to confirm Mycobacterium leprae DNA in any tissue/fluid sample.…”

Section: Introductionmentioning

confidence: 99%

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Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging–Based Study

Polavarapu

Preethish‐Kumar

Vengalil

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Neurotropism and infiltration by Mycobacterium leprae of peripheral nerves causing neuropathy are well established, but reports of central nervous system (CNS) damage are exceptional. We report CNS magnetic resonance imaging (MRI) abnormalities of the brain and spinal cord as well as lesions in nerve roots and plexus in leprosy patients. Eight patients aged between 17 and 41 years underwent detailed clinical, histopathological, and MRI evaluation. All had prominent sensory-motor deficits with hypopigmented and hypo/anesthetic skin patches and thickened peripheral nerves. All demonstrated M. Leprae DNA in affected peripheral nerve tissue. All received multidrug therapy (MDT). Two patients had brainstem lesions with enhancing facial nuclei and nerves, and one patient had a lesion in the nucleus ambiguus. Two patients had enhancing spinal cord lesions. Follow-up MRI performed in four cases showed resolution of brainstem and cord lesions after starting on MDT. Thickened brachial and lumbosacral plexus nerves were observed in six and two patients, respectively, which partially resolved on follow-up MRI in the two cases who had reimaging. The site and side of the MRI lesions corresponded with the location and side of neurological deficits. This precise clinico-radiological correlation of proximal lesions could be explained by an immune reaction in the gray matter corresponding to the involved peripheral nerves, retrograde axonal and gray matter changes, or infection of the CNS and plexus by lepra bacilli. Further study of the CNS in patients with leprous neuropathy is needed to establish the exact nature of these CNS MRI findings.

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Section: Discussionmentioning

confidence: 79%