"Do not diagnose your patient but keep looking and testing, as others have suggested"

 

Leprosy Mailing List – November 6th, 2012

Ref.:    "Do not diagnose your patient but keep looking and testing, as others have suggested"

From:  G Warren, Sydney, Australia

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Dear Dr Noto,

 

Thank you very much to Dr Narahari for referring the case of a 16 years old girl complaining of numbness of whole finger and little pain at the tip of the middle finger [LML Oct. 30th, 2012]. 

 

Yes, I have seen a child with one finger numb, but with no paraesthesia to attract attention.  However when someone really experienced, examined the hand he found the radial nerve on the back of the 2^nd metacarpal was slightly large and definitely harder than normal.  Obviously self-healed if not progressing; but, proper sensory testing may show other sensory defects.  Is it fascinating how in my case it was the radial nerve we could feel and in fact there was some sensory perception on the palm but not on the dorsum.

 

Another early teenager eventually came to me because he had a hand with loss of sensation on the index finger.  He had been complaining so much of that loss of feeling, that 5 years earlier he has been confined in a lunatic asylum- and fortunately someone eventually brought him to our clinic.  The only other things I could find were large lymph nodes in neck and groin and, the report we got back from London was so complimentary as they were marvellous examples of leprosy lymph nodes.  I did not find any other typical signs of leprosy.  He said the finger was numb but we could really confirm that by my testing touch with a ballpoint pen.  (If nothing else is available that can be useful).

 

I have also seen contacts who have definitely slightly enlarged hardish nerves but no obvious complaint; though some may show some neural deficit on very careful sensory testing.  Some of these are the children of lepromatous or BL patients and I assume that they were early contacts who had caught leprosy but cured themselves without leaving obvious clinical signs.

 

In my work around the world I have often examined the children, in their own homes, of previously highly active LL/LB patients.  And have been fascinated as to how many show such subtle signs that they have had the disease and cured themselves and, on a number of occasions they even showed a single nerve on hand and another on foot and another even on neck!

 

Leprosy is a fascinating disease.  Often it is difficult to make a definite diagnosis without the newer laboratory techniques.  However if one checks in the future and follows up one will often eventually make a definite diagnosis before real problems have developed.  Unfortunately many clinicians never even think of the possibility of leprosy.

 

Do not diagnose your patient but keep looking and testing, as others have suggested.

                 

Best regards,

 

Grace Warren

 

 

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LML - S Deepak, B Naafs, S Noto, P A M Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
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