PMID: 6988346Mar 1, 1980Paper

Segmental necrotizing granulomatous neuritis of leprosy

International Journal of Leprosy and Other Mycobacterial Diseases : Official Organ of the International Leprosy Association
S M ChandiC K Job

Abstract

In leprosy, the occurrence of necrotizing nodular lesions in peripheral nerves is a relatively uncommon complication. Despite clinical and gross similarities, there are microscopical differences among groups of such cases, indicating that in all probability different pathogenetic mechanisms are operative. Furthermore, the vast majority of such cases are not true abscesses but are characterized by caseous necrosis and granulomatous inflammation. The traditional collective name "nerve abscess" is therefore inappropriate. Presented herein is an analytic study of 30 cases of the commonest variant, which we suggest should be called segmental necrotizing granulomatous neuritis of leprosy (SNGN). This lesion commonly affects the right ulnar nerve just above the elbow and occurs most often in those with the borderline tuberculoid form of leprosy. It appears to represent the result of a hypersensitivity phenomenon marked by a preponderance of epithelioid cells rather than a reaction of immunity in which lymphocytes predominate. Acid fast bacilli were demonstrable in the lesion in 77% of cases.

Related Concepts

Granuloma
Delayed Hypersensitivity
Leprosy
Mycobacterium leprae (bacteria)
Necrosis
Neuritis, Sensory
Perineurium
Structure of Ulnar Nerve

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