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首页> 外文期刊>Indian journal of leprosy >Pure Neuritic Leprosy with Type 2 reaction
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Pure Neuritic Leprosy with Type 2 reaction

机译：纯神经炎麻风病与2型反应

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Pure neuritic leprosy (PNL) is considered a distinct form of leprosy by Indian Association of Leprologists. Reactions usually reported in PNL are Type 1 reactions manifesting as neuritis with a rare involvement of the skin. We report a case of Type 2 reaction in PNL. This case, a 30 year old male, presented with history of shock like sensation over both upper limbs and lower limbs and tingling numbness for duration of one year. Clinical examination did not reveal any observable patches, plaques or nodules on the entire body. Touch, pain and temperature sensations were impaired on the ulnar aspect of both upper limb and even over both lower limbs. Motor examination revealed weakness of small muscles of both hand. Enlargement of ulnar, ulnar cutaneous nerves, lateral popliteal, anterior tibial and sural nerve was found on both sides with minimal tenderness over the ulnar nerves. Slit skin smears were negative for acid fast bacilli. Nerve conduction study showed asymmetric mixed sensorimotor polyneuropathy. Biopsy from hypoaesthetic area on right forearm revealed mild lymphocytic and macrophage accumulation around the dermal vessels, sweat glands and neurovascular bundles, suggestive of Indeterminate Hansens. Nerve biopsy from right sural nerve gave findings of Lepromatous Hansens neuritis with the epineurium thickened, medial hypertrophy of nutrient artery and neovascularisation. Wade Fite Faraco stain showed multiple acid fast bacilli. Diagnosis of Pure Neuritic Leprosy with Type 1 reaction was made and patient was started on MB-MDT. During the treatment he developed ENL which was successfully managed with Steroids and Thalidomide. It will be important to keep such mixed atypical presentations in mind when dealing with suspected cases of PNL.
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