Peripheral nerve thickening: leprosy

Case contributed by Dr Maulik S Patel

Presentation

Known case of leprosy under treatment. Referred for bilateral venous dopplar to rule out deep venous thrombosis.

Patient Data

Age: 50 years
Ultrasound

Ultrasound shows thickening of bilateral lower limbs nerves.

Bilateral superficial peroneal nerve were thickened just before they become subcutaneous in midleg region. Bilateral deep peroneal nerve thickening was present starting at ankle levels. Divisions of both nerves were thickened up to toe level.

Tibial nerve thickening started in distal leg, its divisions were affected bilaterally.

There was no deep venous thrombosis on either side (and images not uploaded). 

Skin lesions were present in both lower limbs. Image is of left limb.

Case Discussion

A known case of leprosy presented with bilateral distal leg - ankle - foot edema. Color Doppler for deep venous thrombosis was negative for both lower limbs. Patient had multiple skin patches involving both lower limbs from mid thigh to ankle level. He was taking some kind of treatment in another hospital for last few months for this skin lesions. Previous records showed he was under treatment for leprosy. At that time, he presented with complaints of 'glove and stocking type' sensory loss in both lower limbs.

Ultrasound shows thickening of bilateral lower limbs nerves staring at about mid leg level extending to forefoot. 

Even though, there was no histopathology report of nerve biopsy stating etiology of leprosy in previous records; findings of peripheral nerve thickening in this clinical background is very much likely to be due to leprosy.

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Case information

rID: 46586
Case created: 9th Jul 2016
Last edited: 10th Jul 2016
Inclusion in quiz mode: Included

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