Leprotic nerve abscess

Case contributed by Dr Maulik S Patel

Presentation

Histopathologically proven case of lepromatous leprosy under treatment for the last 4 months. Complaining of left posterior medial elbow region pain and swelling for 3 days.

Patient Data

Age: 35 years
Gender: Female
Photo

Photograph showing skin lesions involving posterior medial elbow region.

X-ray

There is diffuse soft tissue swelling involving medial aspect of elbow. There is no joint effusion. There is no bony abnormality.

Ultrasound

Ulnar nerve shows diffuse thickening, hypoechogenesity from proximal mid arm to proximal forearm level. Thickening is maximum just before the cubital tunnel. There is an hypoechoic avascular area in maximally thickened nerve segment.

There is a diffusely thickened, hypoechoechoic cutaneous nerve in the medial elbow. This nerve disappears/joins subcutaneous soft tissue inflammatory hypoechoic area. There are few mobile echoes in this soft tissue inflammatory area. There is local vascularity.

There is no elbow effusion.

Photo

Intra-operative photos of ulnar nerve abscess. 

Case Discussion

A known case of leprosy presents with elbow pain and swelling for a few days. Ultrasound findings suggested thickened ulnar and a cutaneous nerve along with subcutaneous inflammation. Surgical exploration revealed subcutaneous abscess extending into the ulnar nerve and the cutaneous nerve. Nerve abscesses are an uncommon complication of leprosy. 

Intra-operative photos courtesy of the operating surgeon, Dr Niraj I. Patel.

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Case information

rID: 50864
Case created: 25th Jan 2017
Last edited: 28th Jan 2017
Inclusion in quiz mode: Included

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