Leprosy Mailing List – December 9th, 2012
Ref.: During pregnancy women with leprosy are particularly at risk.
From: M E Duncan, Peebles, Scotland, UK
Dear Salvatore,
The message sent in by the Belgian leprologist Dr Theuvenet [LML Nov. 27th, 2012; << Consider nerve decompression when other treatment fails >> ] was very timely.
The need of women with leprosy during and after parturition is not widely recognised. During pregnancy women are particularly at risk. During the first trimester M. leprae start to multiply and in addition there is an inversion of the T and B cell ratio. The first peak of ENL reaction is during the first trimester with a second peak during the third trimester. Severe pain is caused by the development of a nerve abscess on the ulnar nerve just above the elbow.
Nerve decompression was done at ALERT, Addis-Ababa, Ethiopia as an emergency. After cleansing the skin and a miniscule infiltration of lignocaine, a very short incision was made with a sharp scalpel blade. The moment the pressure had gone the patient was pain free. For a longer nerve abscess extending up the ulnar nerve obviously a longer incision is required and the procedure is done under local anaesthesia. The wound was left open and covered with a light sterile dressing.
Best regards,
Lysbeth
Dr ME Duncan <me.duncan@btinternet.com>
LML - S Deepak, B. Naafs, S Noto and P A M Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Contact:-
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83 - Fax: (+39) 010 555 66 41 - E-mail: salvatore.noto@hsanmartino.it
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