Huda Saif, Krishnan Anita
Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
Pract Neurol. 2013 Feb;13(1):39-41. doi: 10.1136/practneurol-2012-000343.
A middle-aged man of South Asian decent presented with a 4-month history of bilateral sensory disturbance affecting the median nerve distribution and dorsum of both feet. Neurological examination was otherwise normal. A patchy absence of sensory responses was noted on nerve conduction studies and electromyogram (NCS/EMG). Over the next 3 months sensory symptoms progressed to involve median, radial, ulnar, sural and peroneal nerves bilaterally. Repeat NCS/EMG confirmed a mononeuritis multiplex predominantly involving the sensory fascicles. Areas of hypopigmentation, a right-lower motor facial weakness and ophthalmic branch trigeminal nerve involvement were noted on examination. Punch skin biopsy as well as sural nerve biopsy demonstrated chronic granulomatous inflammation without evidence of Mycobacterium. A slit skin smear test demonstrated Mycobacterium leprae consistent with a diagnosis of primary neuritic leprosy. In the appropriate clinical context, leprosy should be included in the differential diagnosis of mononeuritis multiplex.
一名南亚裔中年男子出现双侧感觉障碍，累及正中神经分布区域及双足背，病程4个月。神经系统检查其他方面正常。神经传导研究和肌电图（NCS/EMG）显示感觉反应呈斑片状缺失。在接下来的3个月里，感觉症状进展至双侧累及正中神经、桡神经、尺神经、腓肠神经和腓总神经。重复NCS/EMG证实为多灶性单神经炎，主要累及感觉束。检查发现有色素减退区域、右侧面下部运动性肌无力以及三叉神经眼支受累。皮肤打孔活检和腓肠神经活检显示慢性肉芽肿性炎症，未发现结核分枝杆菌证据。皮肤涂片检查发现麻风分枝杆菌，符合原发性神经炎型麻风的诊断。在适当的临床背景下，麻风应纳入多灶性单神经炎的鉴别诊断。
