On the spectrum of leprosy neuropathies: multifocal inflammatory neuropathy heralding leprosy relapse.

We report a 52 year-old woman with a past history of lepromatous leprosy (14 years prior to our first evaluation) who presented with progressive weakness and severe arm/leg pain. CSF analysis revealed elevated protein level with normal cell count. Skin and sural nerve biopsy showed no bacilli. Immunomodulatory treatment led to major improvement on clinical, CSF and electrodiagnostic grounds, but after one year of treatment, skin test revealed leprosy relapse. To our knowledge, this is the first report of a multifocal inflammatory neuropathy heralding leprosy relapse. Extended neurological work-up may be important in unexplained neuropathy progression after leprosy treatment.

Perineuritis in acute lyme neuroborreliosis.

Perineuritis is an unusual cause of direct peripheral nerve injury. We describe the clinicopathologic features of a 56-year-old man with mononeuritis multiplex due to Lyme disease; sural nerve biopsy demonstrated florid perineuritis. Treatment with intravenous ceftriaxone resulted in marked neurologic improvement. This study supports the notion that perineuritis forms part of the pathogenesis in acute Lyme neuroborreliosis.

Detection of Borrelia burgdorferi DNA and complement membrane attack complex deposits in the sural nerve of a patient with chronic polyneuropathy and tertiary Lyme disease.

We report a patient who developed a chronic sensory-motor polyneuropathy and a progressive myelopathy 4 years after a tick bite. An increased serum antibody titer to Borrelia burgdorferi suggested a diagnosis of Lyme neuroborreliosis, although a concomitant cervical spondylosis probably contributed to spinal cord damage. Treatment with ceftriaxone resulted in a marked improvement of neuropathic symptoms, providing indirect evidence of spirochetal infection. Search for B. burgdorferi DNA by polymerase chain reaction amplification on sural nerve confirmed the diagnosis, demonstrating that the spirochete localized in the peripheral nervous system. The presence of complement membrane attack complex deposits and macrophage infiltrates around epineurial vessels and within the endoneurium suggests that the neuropathy in our patient was immune-mediated.

[Primary neural leprosy. Report of a case]. / Lepra neural primaria. A propósito de un caso.

We present the clinical manifestations and morphological characteristics in a case from a patient with familial history of leprosy that presented peripheral neuropathy without cutaneous lesions. The nerves affected showed a loss of myelinated and unmyelinated fibers as well as chronic inflammatory infiltrate. The presence of Hansen's bacillus was demonstrated in macrophages, Schwann cells, endothelial cells, and fibroblasts at light and ultrastructural levels. In this case, the demonstration of the bacillus in the biopsy of peripheral nerve confirmed the diagnosis.

Periodic acid-ethanol gelatin methenamine silver stain for demonstrating M. leprae and myelin in peripheral nerve fibers of leprosy patients.

We have introduced the periodic acid-ethanol gelatin methenamine silver stain for the simultaneous demonstration of Mycobacterium leprae and myelin in the peripheral nerves of leprosy patients.

Somatosensory and autonomic neuropathy as the only manifestation of long standing leprosy

The clinical and neuropathological findings an a patient with "neuritic" leprosy are described. In this rare form of leprosy, skin changes are only minimal or absent anf the diagnosis can be established only by nerve biopsy

A comparative evaluation of bacteriologic and morphologic indices of Mycobacterium leprae in skin, lymph node, bone marrow, nerve and muscle.

This study elicits the comparative evaluation of the Bacteriologic Index (BI) and Morphologic Index (MI) of the skin, lymph node, bone marrow, nerve and muscle tissues of 15 untreated leprosy patients. The findings of comparable or even higher BI's and MI's in lymph nodes than skin are of considerable interest, especially the presence of a significant percentage of viable bacilli during reaction states when MI of skin and nerve tissue was found to be negative. Evaluation of the BI's and MI's of lymph nodes has been suggested to be of utmost importance for follow-up studies of patients being treated with antileprosy drugs.