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Volume 2024, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Introduction: Segmental necrotizing granulomatous neuritis (SNGN) is a rare complication of leprosy involving peripheral nerves. It can appear alone in cases of pure neuritic leprosy or in combination with cutaneous lesions.

Case Presentation: A 15-year-old female diagnosed with borderline tuberculoid leprosy who received prior multidrug therapy presented 2 years later with occasional pain and tingling sensations along the inner aspect of her right arm and forearm. Imaging findings suggested SNGN, which was corroborated by cytopathological examination. She was considered relapsed from leprosy, and multi-drug therapy and steroids were started, following which she reported a decrease in the size of the swelling along with no further deterioration of the sensorineural deficit.

Discussion: SNGN, which is one of the rare complications of leprosy, can create diagnostic dilemmas as its differential diagnoses include reversal reactions, and peripheral nerve tumors (such as schwannoma and neurofibroma), which have been outlined in this article. SNGN is more likely when magnetic resonance imaging (MRI) shows a well-defined ovoid lesion with central necrosis and peripheral rim enhancement.

Conclusion: The incidence of SNGN is on the rise due to multi-drug therapy. In our case, the patient developed SNGN, which was considered a relapse from leprosy, and multi-drug therapy and steroids were started, following which the patient reported a significant reduction in the size of the swelling with no further deterioration of the sensorineural deficit. Hence, an appropriate diagnosis of SNGN through ultrasonography and MRI will lead to favorable outcomes, ultimately benefiting the patient.

© 2024 Netam, Gupta, Chandrakar, Licensee HBKU Press.
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2024-08-06
2024-09-05
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References

  1. Richardus JH, Kar HK, Bakirtzief Z, van Brakel WH. Leprosy. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, Eds. Harrison’s principles of internal medicine. 21st ed. New York, NY:McGraw Hill;2022. p. 1382–92.
    [Google Scholar]
  2. Singh GP. Psychosocial aspects of Hansen’s disease (leprosy). Indian Dermatol Online J. 2012Sep; 3:(3):166–70. doi: 10.4103/2229-5178.101811
     [Google Scholar]
  3. Chandi SM, Chacko CJ, Fritschi EP, Job CK. Segmental necrotizing granulomatous neuritis of leprosy. Int J Lepr Other Mycobact Dis. 1980Mar; 48:(1):41–7. PMID: 6988346
     [Google Scholar]
  4. Kaimal S, Thappa DM. Relapse in leprosy. Indian J Dermatol Venereol Leprol. 2009Mar–Apr; 75:(2):126–35. doi: 10.4103/0378-6323.48656
     [Google Scholar]
  5. Jayalakshmy PS, Prasad PH, Kamala VV, Aswathy R, Pratap P. “Segmental necrotizing granulomatous neuritis”: A rare manifestation of Hansen disease-report of 2 cases. Case Rep Dermatol Med. 2012; 2012:758093. doi: 10.1155/2012/758093
     [Google Scholar]
  6. Martinoli C, Bianchi S, Dahmane M, Pugliese F, Bianchi-Zamorani MP, Valle M. Ultrasound of tendons and nerves. Eur Radiol. 2002Jan; 12:(1):44–55. doi: 10.1007/s00330-001-1161-9
     [Google Scholar]
  7. Elias J Jr, Nogueira-Barbosa MH, Feltrin LT, Furini RB, Foss NT, Marques W Jr, et al.. Role of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation. J Ultrasound Med. 2009Sep; 28:(9):1201–9. doi: 10.7863/jum.2009.28.9.1201
     [Google Scholar]
  8. Kulkarni M, Chauhan V, Bharucha M, Deshmukh M, Chhabra A. MRI imaging of ulnar leprosy abscess. J Assoc Phys India. 2009Feb; 57:175–6. PMID: 19582989
     [Google Scholar]
  9. Hari S, Subramanian S, Sharma R. Magnetic resonance imaging of ulnar nerve abscess in leprosy: A case report. Lepr Rev. 2007Jun; 78:(2):155–9. Erratum in: Lepr Rev. 2007 Dec;78(4):434. doi: 10.47276/lr.78.2.155
     [Google Scholar]
  10. Lin J, Martel W. Cross-sectional imaging of peripheral nerve sheath tumors: Characteristic signs on CT, MR imaging, and sonography. AJR Am J Roentgenol. 2001Jan; 176:(1):75–82. doi: 10.2214/ajr.176.1.1760075
     [Google Scholar]
  11. Sultan M, Choudhary M, Siddique M, Lavhale N, Badhe PV. Hansen’s disease with pure nerve involvement and perineural abscess mistaken for peripheral nerve sheath tumour. Eur Med J. 2023. doi: 10.33590/emj/10306433
     [Google Scholar]
  12. Martinoli C, Derchi LE, Bertolotto M, Gandolfo N, Bianchi S, Fiallo P, et al.. US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol. 2000Mar; 29:(3):142–50. doi: 10.1007/s002560050584
     [Google Scholar]
  13. Salafia A, Chauhan G. Nerve abscess in children and adults leprosy patients: Analysis of 145 cases and review of the literature. Acta Leprol. 1996; 10:(1):45–50. PMID: 8865948
     [Google Scholar]
  14. Mittal A, Dhanota DPS, Saggar K, Ahluwalia A. Brachial plexopathy with ulnar nerve abscess in leprosy: A case showing importance of magnetic resonance neurography with clinical, imaging and histopathological correlation. Indian J Dermatol Venereol Leprol. 2022May–Jun; 88:(3):385–8. doi: 10.25259/IJDVL_405_2021
     [Google Scholar]
/content/journals/10.5339/qmj.2024.36
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A case report on imaging findings of rare segmental necrotizing granulomatous neuritis of leprosy involving ulnar nerve
Qatar Medical Journal 2024, 36 (2024); https://doi.org/10.5339/qmj.2024.36
/content/journals/10.5339/qmj.2024.36
/content/journals/10.5339/qmj.2024.36
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  • Article Type: Case Report
Keyword(s): Abscess, leprosy, magnetic resonance imaging, ulnar nerve and ultrasonography

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