(LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

Leprosy Mailing List – April 21,  2018

Ref.:    (LML) To differentiate between diabetic neuropathy and pure neuritic leprosy neuropathy

From:  Wim Theuvenet, Apeldoorn, the Netherlands

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Dear Pieter,

 

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.

 

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com