RESUMO
INTRODUCTION: We sought to compare median nerve elasticity between leprosy patients (LPs) and healthy volunteers (HVs) using ultrasound elastography (UE). METHODS: Two radiologists independently measured the strain ratio of the median nerve/flexor digitorum superficialis muscle (MN/FDSM) of 18 LP and 18 HV using real-time freehand UE. Statistical analysis included intra-class correlation coefficients (ICC) and Mann-Whitney test. RESULTS: The MN/FDSM strain ratios of the LP and HV were 2.66 ± 1.30 and 3.52 ± 0.93, respectively (P < 0.05). We observed a significantly lower MN/FDSM strain ratio in LP with reactions (types 1 and 2 cutaneous reactions associated with or without neuritis) (2.30 ± 0.91) compared with LP without reactions (3.60 ± 1.70). We found no significant differences between HV and LP without reactions. The intra- and inter-observer ICCs were 0.50 (95% confidence interval [CI], 0.11-0.72) and 0.34 (95% CI, 0.28-0.52), respectively. CONCLUSIONS: MN/FDSM strain ratios were significantly lower in LP with reactions. UE may be useful for nerve elasticity evaluation in leprosy. Muscle Nerve 56: 393-398, 2017.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Hanseníase/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço/diagnóstico por imagem , Antebraço/inervação , Antebraço/fisiopatologia , Humanos , Hanseníase/fisiopatologia , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Estudos Prospectivos , Adulto JovemRESUMO
Leprosy is an infectious disease of prevalence still high in endemic areas in Brazil. The neurological presentation depends on the involved nerve and is usually associated with skin lesions and the formation of multiple abscesses. We present a case of isolated tuberculoid leprosy, discuss the occurrence, the differential diagnosis and the treatment of this rare presentation and reaffirm the importance of considering leprosy in the differential diagnosis of patients with polyneuropathy or nerve enlargement with no skin lesions.
Assuntos
Antebraço/inervação , Antebraço/patologia , Hanseníase Tuberculoide/patologia , Doenças do Sistema Nervoso Periférico/microbiologia , Doenças do Sistema Nervoso Periférico/patologia , Adulto , Antibióticos Antituberculose/uso terapêutico , Brasil , Dapsona/uso terapêutico , Granuloma/microbiologia , Granuloma/patologia , Granuloma/fisiopatologia , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Tuberculoide/microbiologia , Hanseníase Tuberculoide/fisiopatologia , Masculino , Doenças do Sistema Nervoso Periférico/fisiopatologia , Rifampina/uso terapêutico , Resultado do TratamentoRESUMO
The author relates a rare case of cutaneous-brachial nerve mononeuritis in a Hansen's disease patient, presenting a pure neural tuberculoid form, with spontaneous drainage of abscess.
Assuntos
Antebraço/inervação , Hanseníase Tuberculoide/patologia , Neurite (Inflamação)/patologia , Adulto , Humanos , MasculinoRESUMO
A study was done on the characteristics of infiltrating cells in the nerves of 9 patients with pure neuritic leprosy, by preparing a single cell suspension. The patients had no skin lesion. Histopathological examination revealed that 2 of the 9 nerves showed granulomas characteristics of tuberculoid leprosy, while the remaining 7 had features of lepromatous granulomas. In the nerves showing tuberculoid granulomas, a high proportion of lymphocytes were T cells as they formed rosettes with sheep erythrocytes and only a few percent were EAC rosette forming cells. On the other hand, the nerves showing lepromatous granulomas contained only occasional lymphocytes which formed E and EAC rosettes. Macrophages from the granulomas of all the nerves were esterase positive, peroxidase negative, contained M. leprae and did not exhibit C3 surface receptors.