Leprosy Mailing List – April 28, 2018
Ref.: (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy
From: Salvatore Noto, Aosta, Italy
Thank you very much to Dr Ramesh Sharma for his message dated LML April 20, 2018 about a patient in Pokhara, Nepal and the differential diagnosis of leprosy and diabetes neuropathies.
Thank you also to Drs Eric Slim (I did not know that nerve enlargement is seen in diabetes [if it were true, this would cut off a cardinal sign of leprosy]), Willem Theuvenet, Atul Shah and VP Shetty.
Herewith I try to give some answers and comments to Dr Sharma's questions. In attachment is a PDF document with 7 slides where are shown clinical pictures of ulnar, median, common peroneal and posterior tibial nerves damaged by leprosy.
My answer to the 1° question is yes, there is a point in "differentiate between diabetic and pure neural [leprosy] neuropathy" because Dr Sharma's patient has the diagnosis of diabetes but, he still does not have the diagnosis of leprosy. In acute leprosy neuropathy treatment would be different.
About the 2° question:- I think we can clinically differentiate the two conditions in those cases where the signs are fully developed and sequelae have not altered the initial clinical picture, not in other cases.
Typical ulnar and median nerves deformities are seen in leprosy, kindly see slides 1-5. Are they seen in diabetes?
Common peroneal nerve damage that leads to a dropped and inverted foot is seen in leprosy and trauma. The leprosy patient shown in slide 6 is unable of dorsi-flection of the right foot. Slide 7 is a leprosy patient with severe sensory and autonomic loss on his feet. Do diabetes cause the same?
Patients with foot ulcers and gross foot deformities are seen in several conditions, leprosy, diabetes, hereditary neuropathies among the others; here clinical diagnosis may be impossible.
About the 3° question please see comments of Dr. VP Shetty. It may be useful contacting the involved pathologist, before proceeding to the nerve biopsy.
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
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