Abstract Details

Title Leprosy Late-Onset Neuropathy (LLON) Clinical Presentation Forms

Topic Infections/AIDS/Prion Disease

Presentation(s) P06 - (-)

Poster/Presentation
Number 192

Objective

Background BACKGROUND: A painful neuropathy (PN) with no concurrent cause apart from a past history of cutaneous leprosy successfully treated many years before and considered as LLON have been reported.

Design/Methods DESIGN/METHODS: Skin leprosy patients, previously treated with multidrug therapy (MDT), were referred for neurological evaluation due to a recent neuropathy development. They all had been excluded for an active leprosy infection or reinfection. "Ongoing-neuropathy" in leprosy patients who have completed MDT was also excluded. Electrophysiological examination and sural nerve biopsy were performed. Wade-Fite acid-fast stain for leprosy bacilli was performed. Prediabetes, diabetes, other metabolic or endocrine disorders, vascular or collagen diseases, HIV, HTLV-1/2, HBV and HCV-virus infections, cancer, and other causes of neuropathies were ruled out, clinically and laboratorially.

Results RESULTS: Eight patients were included. A painful multiplex neuritis or asymmetric polyneuropathy (multiple neuritis summation) were observed respectively in 4 and 2 patients (4 male; 2 female). The mean patient age in this painful group was 48.83 years (36- 64). The mean time interval of the recent neuropathy from the previous MDT was 20.3 years (12-26). Other 2 male patients (76 and 74 y.o.) presented an ataxic polyneuropathy respectively 40 and 47 years after a skin leprosy treatment. Electrophysiological studies disclosed a sensory axonal neuropathy in 5 cases, and demyelinating features in one. Inflammatory infiltrates with microvasculitis (6 cases) with no bacilli was seen in nerve biopsy in all cases. Neuropathic symptoms improved with prednisone in 5 or with intravenous immunoglobulin in 3 cases.

Conclusions CONCLUSIONS: We consider these cases as being of LLON, which include painful multiplex neuritis or asymmetric polyneuritis, and ataxic polyneuropathy presentation forms. LLON should be considered facing patients referring previous cutaneous leprosy treatment many years before.

Authors/Disclosures
Osvaldo J. Nascimento, MD, PhD, FAAN (Fluminense Federal University) PRESENTER	Dr. Nascimento has nothing to disclose.
Camila Pupe, MD	Dr. Pupe has nothing to disclose.
Eduardo R. Davidovich	Dr. Davidovich has nothing to disclose.
	No disclosure on file
Andre P. Matta, MD (Eisai)	Dr. Matta has received personal compensation for serving as an employee of Sanofi. Dr. Matta has received stock or an ownership interest from Sanofi.
	No disclosure on file
Marcos R. De Freitas, MD, PhD (Univ Federal Fluminense)	No disclosure on file
Helen Colquhoun	Helen Colquhoun has received personal compensation for serving as an employee of Sage Therapeutics. Helen Colquhoun has stock in Sage Therapeutics. Helen Colquhoun has received intellectual property interests from a discovery or technology relating to health care.

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