Jaiswal Navya, Chakraborti Shrijeet, Nayak Kashinath, Pai Shivananda, Shelley B P, Sreeram Saraswathy, Rakshith K C, Suresh B V, Misri Z K, Alva Hansraj, Shankar N
Department of Pathology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
Department of Dermatology, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India.
J Neurosci Rural Pract. 2018 Jan-Mar;9(1):42-55. doi: 10.4103/jnrp.jnrp_438_17.
Leprosy affecting the nerve solely or with concomitant skin lesions is not an uncommon condition in clinical practice. It is responsible for extensive morbidity and often poses a diagnostic challenge. This study aims to highlight the clinicopathological features of Hansen's neuritis (HN).
In this retrospective study, cases of histologically diagnosed HN, from January 2010 to July 2017, were reviewed in the light of clinical features, treatment history, and outcome.
There were 18 cases of HN which accounted for 3.97% of total nerve biopsy samples ( = 453) and 0.02% of total histopathology samples ( = 81,013). The male: female ratio was 5:1 in the cases of HN. Age range was 20-79 years with a mean age of 42.4 years (standard deviation: ±14.03). Among the HN cases, there were 13 cases of pure neuritic leprosy (61.1%). Mononeuritis multiplex was the most common finding in the nerve conduction study. Six (33.3%) cases exhibited histological features of borderline tuberculoid leprosy, followed by five (27.8%) cases of mid-borderline features, three (16.7%) cases each of borderline lepromatous and burnt-out HN, and one (5.6%) case of polar tuberculoid leprosy. Lepra bacilli were detected on Fite-Faraco stain in 44.4% cases.
Diagnosis of HN depends on astute search for skin lesions, nerve thickening or tenderness, sensory or motor symptoms, histopathological examination, and demonstration of lepra bacilli.
在临床实践中，麻风仅累及神经或伴有皮肤损害的情况并不少见。它会导致广泛的发病率，并且常常带来诊断挑战。本研究旨在突出汉森神经炎（HN）的临床病理特征。
在这项回顾性研究中，对2010年1月至2017年7月间组织学诊断为HN的病例，根据临床特征、治疗史和结局进行了回顾。
有18例HN病例，占神经活检样本总数的3.97%（n = 453），占组织病理学样本总数的0.02%（n = 81,013）。HN病例中男女比例为5:1。年龄范围为20 - 79岁，平均年龄为42.4岁（标准差：±14.03）。在HN病例中，有13例为纯神经炎型麻风（61.1%）。多灶性单神经炎是神经传导研究中最常见的表现。6例（33.3%）表现为界线类偏结核样型麻风的组织学特征，其次是5例（27.8%）具有中间界线类特征，界线类偏瘤型和消退期HN各3例（16.7%），极重型结核样型麻风1例（5.6%）。44.4%的病例在Fite - Faraco染色中检测到麻风杆菌。
HN的诊断取决于对皮肤损害、神经增粗或压痛、感觉或运动症状、组织病理学检查以及麻风杆菌的检测进行敏锐的排查。
