Clinical and diagnosis aspects of the primarily neural leprosy

RESUMO

A total of 33 patients, 28 males and five females, from nine to 87 years of age, with suspected leprosy associated peripheral neuropathy, without detectable skin lesion or positive skin bacilloscopy, were studied during the period of 1994 to 2004. Patients were submitted to dermatological and neurological examination, electrophysiologic tests, Mitsuda reaction and nerve biopsy. Samples for histopathological exams were stained with hematoxillin-eosin, Faraco-Fite and immunohistochemistry with anti- BCG antibodies. Among patients with suspected leprosy, the clinical presentation of polyneuropathy occurred in 17 (51,51%) patients while 13 (39,39%) presented mononeuropathy multiplex and 3 (9,1%) mononeuropathy. The hematoxillin-eosin and Faraco-Fite stainings confirmed the leprosy diagnosis in 10 (30,30%) patients. Three patients presented a borderline pattern, two tuberculoid and no characteristic histological pattern was observed in the remaining five patients. The final calssification depended on the clinical-histological correlation. Immunohistochemistry increased the diagnosis to 11 (33,33%) cases. Among the remaining 22 patients, three patients had leprosy confirmed, one was clinically understood as a primarily neural leprosy, probably tuberculoid form of the childhood, increasing the diagnosis to 14 (42,43%) cases. From the remaining patients, 19 (57,57%) were excluded during the follow-up. The primarily neural leprosy (PNL) is an unusual leprosy presentation and a complex form to diagnose. The clinical follow-up accompanied by the improvement of histopathological examination of the nerve may add more accuracy to the investigation of the suspected leprosy neuropathies