Management of nerve abscess in leprosy

Leprosy Mailing List, August 27th, 2008
Ref.: Management of nerve abscess in leprosy.
From: Warren G., Sydney, Australia



Dear Salvatore,

I refer to Dr Ranthilaka Ranawaka’s message dated LML Aug. 25th, 2008 about management of multiple nerve abscesses in leprosy.

The fact that the patient has now got abscesses suggests that she has eliminated the infection and her white cells have destroyed the bacilli etc and left the pus. What the writer does not say is if there is any inflammation round the abscess sites. There may be a secondary infection that does need treatment by use of some drawing medication like sugar paste or magnesium sulphate and glycerine paste (BPC>). They rarely need anti-bacterials.

However in many that I have seen the abscesses, if not to large, will eventually absorb in 3-6 months leaving just a little patch of scar in the nerve which is probably non functioning beyond that point anyhow. There is usually no need to remove the abscess; unless it is very large and/or inflamed or causing pain or likely to get traumatised in daily living, etc. I have seen dozens. The only one I remember opening had about 400cc of pus in it, and was just above the elbow and in danger of being ruptured!

I would assume the abscesses are in the original lesion (?) and not further up the nerve. If she was true tuberculoid it is unlikely that there are any other lesions; but her whole body needs to be inspected. Was she in fact really BT? Has she other lesions elsewhere? Is she really multibacillary but started as a TT and has now down graded?

In fact does she need more MDT? I would suspect so and I would in deed give her at least 6 months more to make sure. I do not like relapses!

I do not know the prevalence of DDS resistance in your country. It may be better to give her 6 months of clofazimine which is an effective anti-leprotic and anti-inflammatory and we have not yet seen a patient develop resistance to clofazimine. I often use it alone (as we did in the 1960s in the initial trials) and it is very effective at cleaning up problems, reducing reaction and eliminating bacilli. That also eliminates the risk associated with Rifampycin especially in the elderly who may have liver problems that are aggravated by Rifampycin.

Thank you very much for sharing with us your clinical cases.

Best wishes,

Grace Warren