Leprosy Mailing List – April 21, 2018
Ref.: (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy
From: Wim Theuvenet, Apeldoorn, the Netherlands
Thanks to Dr. Sharma for sharing this dilemma (LML, April 20, 2018).
There may be a few considerations to assist in the differential diagnosis:
1. DM peripheral neuropathy will in general be more symmetrical/bilateral;
2. DM neuropathy tends to affect the lower extremities far more often /much earlier than the upper limbs;
3. DM neuropathy will manifest itself after a much longer duration after the onset of the disease;
4. With ultrasound you may see the (a)symmetry of the nerve enlargement;
5. A cytological needle aspiration of enlarged nerves, when showing AFB's will set the diagnosis of leprosy;
6. When still inconclusive I would treat as MB leprosy seeing the extend of the nerve involvement;
7. When not done yet would suggest to have a full PT function assessment and when there are serious functional problems to present the patient to Dr. Indra Napit, Anandaban Hosptal, for possible reconstructive surgery/ tendon transfers?
With very best wishes
Willem J.Theuvenet M.D, Ph.D
Plast.Rec. Surgeon and Consultant for TLMI and the NLR.
LML - S Deepak, B Naafs, S Noto and P Schreuder
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