Leprosy Mailing List – April 20, 2018
Ref.: (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy
From: Ramesh Sharma, Pokhara, Nepal
This is Dr. Ramesh Sharma, Dermatologist, working in Greenpastures' Hospital, Pokhara, Nepal which is a leprosy mission hospital.
We come across some confusing cases regarding pure neuritic leprosy. We, at present, have a patient in our ward who has uncontrolled diabetes (HbA1c: 10.3) and subjective nerves enlargement with sensory loss of the hands and feet and motor atrophy of the muscles of the hands only. 'Nerve enlargement' in this patient could only be a subjective finding. It's been difficult for us to distinguish between peripheral neuropathy of diabetes and pure neuritic leprosy.
1. Is there any point as to differentiate between diabetic and pure neural neuropathy?
2. Can we differentiate them by the atrophy of muscles (in Hansens disease) along with sensory loss?
3. We have not yet done a nerve biopsy (its on our plan). But, if we do a nerve biopsy, can it be taken as conclusive to rule in or rule out a pure neuritic leprosy?
Looking forward to your reply.
LML - S Deepak, B Naafs, S Noto and P Schreuder
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