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CORRESPONDENCE
Year : 2012  |  Volume : 60  |  Issue : 6  |  Page : 687-688

Mononeuritis multiplex following leptospirosis


Department of Neurology, Medical College, Calicut, Kerala, India

Date of Submission04-Nov-2012
Date of Decision20-Nov-2012
Date of Acceptance05-Nov-2012
Date of Web Publication29-Dec-2012

Correspondence Address:
K Saifudheen
Department of Neurology, Medical College, Calicut, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.105230

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How to cite this article:
Saifudheen K, Satish H, Varghese P, Gafoor V A, Jose J. Mononeuritis multiplex following leptospirosis . Neurol India 2012;60:687-8

How to cite this URL:
Saifudheen K, Satish H, Varghese P, Gafoor V A, Jose J. Mononeuritis multiplex following leptospirosis . Neurol India [serial online] 2012 [cited 2019 Aug 21];60:687-8. Available from: http://www.neurologyindia.com/text.asp?2012/60/6/687/105230


Sir,

We read with interest the articles describing rare neurological complication following leptospiral infection. [1] In this context, we report a rare case of mononeuritis multiplex following leptospirosis.

A 45-year-old man presented with weakness and numbness of both upper limbs of 4 days duration after 1 week of documented leptospiral infection of 2 weeks duration. On examination, he had weakness of both wrist and finger extension and winging of left scapula and bilateral sluggish triceps reflex [Figure 1]. There was mild sensory impairment on the radial side of both forearms. Nerve conduction study revealed bilateral radial nerve axonal sensory-motor neuropathy in the form of reduced amplitude of compound muscle action potentials as well as sensory nerve action potentials with normal conduction velocities. Laboratory workup was normal and immunological tests were negative. His previous admission record showed white blood cell count of 12,000 cell/mm 3 with polymorph predominance, normal hemoglobin, platelet count of 88,000/mm 3 and erythrocyte sedimentation rate of 86 mm/h, and blood biochemistry: Urea-112 mg/dL, creatinine-2.5 mg/dL, bilirubin-4 mg/dL (direct 2.5 mg/dL), total protein 6.8 g/dL (albumin-3.5 g/dL), elevated serum glutamic oxaloacetic transaminase and glutamic pyruvic transaminase (90 and 124 U/L, respectively), serum alkaline phosphatas-110 U/L, and creatinine kinase-290 U/L. Ultrasonography of abdomen showed mild hepatomegaly. Serologic tests were negative for hepatitis A, B, and E virus, HIV, dengue, and rickettsial infection. The diagnosis of leptospirosis was confirmed by the Enzyme-linked immunosorbent assay IgM. He was started on dexamethasone 12 mg/day for 1 week followed by tapering dose of prednisolone for 3 weeks. At the last follow-up after 3 months, his wrist drop improved fully with mild residual winging of scapula.

Post-infectious mononeuritis has been described with different viral and bacterial infections, but mononeuritis following leptospirosis is rare. Leptospirosis is a biphasic disease that begins with fever, chills, myalgias, and headache. After the organism gains entry via intact skin or mucosa, it multiplies in blood and tissue and can affect any organ of the body, particularly, liver and kidney. Second phase is called the immune or leptospiruric phase because circulating antibodies may be detected. During this phase the organism may be isolated from urine but may not be recoverable from blood or cerebrospinal fluid (CSF). This stage occurs as a consequence of the host immunologic response to infection and lasts 3-30 days or even more. Nervous system involvement is essentially immune-mediated and the presentations include aseptic meningitis, myeloradiculopathy, myelopathy, Guillain-Barrι syndrome-like presentation, mononeuritis, facial palsy, meningo-encephalitis, intra-cerebral hemorrhage, cerebellar dysfunction, iridocyclitis, and tremor or rigidity. [2] The commonest manifestation of neuro-leptospirosis is aseptic meningitis and 50-90% of patients have CSF pleocytosis. [3]
Figure 1: Picture shows wrist drop and winging of scapula

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  References Top

1.Pradhan S, Tandon R, Kishore J. Combined involvement of muscle, nerve, and myoneural junction following leptospira infection. Neurol India 2012;60:514-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Yaqoob M, Ahmad R. Mononeuritis multiplex as an unusual complication of leptospirosis. J Infect 1989;19:188-9.  Back to cited text no. 2
    
3.Abraham M. The central nervous system in leptospirosis. Kerala Med J 1998;38:21-2.  Back to cited text no. 3
    


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