Nerve conduction studies in paucibacillary and multibacillary leprosy: a comparative evaluation.

Involvement of peripheral nerves in patients with leprosy results in sensory, motor and autonomic dysfunctions along with deformities and disability. Pattern of nerve involvement is different for different forms of leprosy. In this study, we evaluated and compared the nerve conduction parameters of paucibacillary leprosy with that of multibacillary leprosy. In this study, 40 consecutive patients of leprosy (19 cases of paucibacillary and 21 cases of multibacillary leprosy) were included. Nerve conduction studies were performed according to the standard procedure described in the manual of the machine. We observed that patients with multibacillary leprosy had significantly more severe changes in nerve conduction parameters as compared to that of paucibacillary leprosy. In paucibacillary leprosy, the dominant pattern of nerve involvement was that of mononeuropathy, however, in 6 paucibacillary cases the nerve involvement was in form of mononeuritis multiplex. Electrophysiological assessment also revealed involvement of clinically uninvolved nerves. Nerve conduction parameters were suggestive of mixed axonal as well as demyelination of the peripheral nerves.

Leprosy: a precipitating factor for complex regional pain syndrome.

Complex regional pain syndrome (CRPS) usually develops after trauma. We are reporting the first case of CRPS with leprosy as a precipitating cause. A fifty-five-year male presented in the pain clinic with complaint of pain and swelling in the right arm. There was no history of trauma to the limb. On reviewing the history, patient was found to be on treatment for leprosy. X-ray of the right hand showed severe osteoporosis. A diagnosis of CRPS associated with leprosy was made. A diagnostic stellate ganglion block relived his pain completely. Thereafter patient is on treatment with tablet etoricoxib 90 mg once a day, gabapentin 100 mg twice a day and continuing to have 100% pain relief. The diagnosis of the type of CRPS was difficult in our case as no history of trauma or neurological injury was present. The presence of leprosy along with ulnar nerve thickening may be the precipitating factor for CRPS, this has not been reported so far in the literature. We managed the patient with sympathetic block along with medical therapy for chronic pain and leprosy chemotherapy.

Granulomatous hepatitis: a retrospective study.

51 cases of granulomatous hepatitis were seen among 1234 liver biopsies over a 10 year period. Tuberculosis was the commonest cause seen in 55 percent of cases. Other causes included leprosy, sarcoidosis, histoplasmosis, brucellosis, amoebic liver abscess, lymphoma and malignant granuloma. 12 percent of cases remained undiagnosed. Clinically these patients presented with pyrexia and hepatosplenomegaly. Jaundice was uncommon. Many showed elevated alkaline phosphatase levels, anaemia and raised ESR Granulomatous hepatitis of unknown aetiology with FUO was seen in 6 percent cases only.

Thyroid function in leprosy.

Thyroid function tests were carried out in 43 cases of leprosy. The study subjects included cases of tuberculoid, borderline and lepromatous leprosy and those with lepra reaction. The parameters studied included serum cholesterol, protein bound Iodine, serum T3 level and serum T4 levels. The levels of serum cholesterol and protein bound Iodine were normal in all the four groups of leprosy patients. However, the mean serum T3 and T4 were low in all the four groups. The difference in the levels of serum T3 was statistically significant only in the lepra reaction group. The levels of T4 were statistically significantly decreased in borderline leprosy, lepromatous leprosy and in lepra reaction.

Glucose tolerance test in leprosy.

Glucose tolerance test was carried out in 43 cases of leprosy. They included cases of tuberculoid, borderline, lepromatous leprosy and those with lepra reaction. It was observed that normal curve was common in tuberculoid leprosy. Flat glucose tolerance curve was observed in borderline and lepromatous leprosy. However, the diabetic curve was common in Lepra reaction. Fasting blood sugar was low in lepromatous leprosy and it tended to be marginally high in lepra reaction. Normal GTT response was observed in those with duration of disease between 0-6 months, flat curves in those with duration of disease between 7-12 months while diabetic curve was more common in those with disease duration of more than 2 years.

Hormone profile in leprosy.

Hormone profile were carried out in 35 male cases of leprosy. They were divided into tuberculoid leprosy, borderline leprosy, lepromatous leprosy and lepra reaction. Serum testosterone, follicle-stimulating hormone, Luteinizing hormone, and Oestradiol level were measured in these cases of leprosy. It was observed that serum testosterone were significantly low in lepromatous leprosy (P less than 0.001) and lepra reaction (P less than 0.01). The serum levels of follicle-stimulating hormone and luteinizing hormone were significantly high in lepromatous leprosy (P less than 0.02) and lepra reaction (P less than 0.05). Serum Oestradiol was raised in approx. 60% cases in borderline leprosy, lepromatous leprosy and lepra reaction.

Adreno-cortical function in leprosy.

Adreno cortical function was carried out in 43 cases of leprosy. These cases were further divided into tuberculoid, borderline, lepromatous and Lepra reaction. Serum and urinary electrolyte, urinary 17-Ketosteroid and 17-Ketogenic steroid and plasma cortisol levels were measured to assess the adrenocortical status in these different forms of leprosy. It was observed that these parameters were within normal limit in tuberculoid leprosy except low value of urinary 17-Ketogenic steroid. The borderline and Lepromatous leprosy cases revealed low values of urinary sodium, potassium and 17-Ketogenic steroid and high level of serum potassium. However, the cases of lepra reaction revealed low value of serum and urinary sodium and potassium, urinary 17-Ketogenic steroid. The basal plasma cortisol level was high in this group but it was statistically insignificant.