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NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 837-838

Visibly enlarged feeder nerve in Hansen disease


Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Pondicherry, India

Date of Submission11-Jun-2021
Date of Decision28-Nov-2021
Date of Acceptance12-Dec-2021
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Vijayasankar Palaniappan
Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Pondicherry – 605 107
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344658

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How to cite this article:
Palaniappan V, Karthikeyan K. Visibly enlarged feeder nerve in Hansen disease. Neurol India 2022;70:837-8

How to cite this URL:
Palaniappan V, Karthikeyan K. Visibly enlarged feeder nerve in Hansen disease. Neurol India [serial online] 2022 [cited 2022 Jun 27];70:837-8. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/837/344658




A 27-year-old woman, a known case of borderline tuberculoid (BT) Hansen disease for 3 months, presented with burning sensation and pain over her pre-existing lesions, which started 1 month after the initiation of multidrug therapy (MDT). On physical examination, she had well- to ill-defined erythematous edematous plaques over the posteromedial aspect of right elbow and forearm [Figure 1]. On clinical evaluation of peripheral nerves, the right-side ulnar nerve was thickened (Grade III) and tender (Grade II) by the World Health Organization (WHO) standards. Interestingly, the patient strikingly had grossly visible thickened feeder nerve supplying the Hansen patch. On palpation, it was tender and irregularly thickened [Figure 2]. A punch biopsy for histopathologic examination was taken from the patch and was consistent with our clinical findings. There were no motor deficits. A diagnosis of BT Hansen disease in reversal reaction was made. The patient was asked to continue MDT and started on oral analgesics and steroids.
Figure 1: Well- to ill-defined erythematous edematous plaques over the posteromedial aspect of right elbow and forearm

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Figure 2: Arrow shows visibly enlarged nerve to patch

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Mycobacterium leprae is an obligate neurotrophic intracellular bacterium with a predilection to spread from superficial dermal neurovascular bundle by adhering to endoneural and perineural endothelial cells. By targeting the Schwann cells, it spreads in a transaxonal route, thereby affecting the superficial dermal and intracutaneous nerves of the skin. The lower temperature of superficial nerves (28°C–32°C) is conducive for M. leprae multiplication.[1] In tuberculoid and BT Hansen disease, the sensory cutaneous nerves running to the proximal edge of the patch (feeding nerve) may be thickened as in our case.[2] However, this gross, clinically visible enlargement of cutaneous nerve is uncommon.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shelley BP, Shenoy MM. Revisiting Hansen's disease: Recognizing the many neurodermatologic faces and its diagnostic challenges. Arch Med Health Sci 2018;6:157-70.  Back to cited text no. 1
  [Full text]  
2.
Hastings RC. Leprosy. 2nd ed. Edinburgh: Churchill Livingstone; 1994.  Back to cited text no. 2
    


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