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Leprosy with ulnar nerve abscess: ultrasound findings in a child

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Abstract

We report the ultrasound findings of a typical case of nerve abscess due to leprosy in an 11-year-old boy. The patient had previously undergone pediatric multibacillary leprosy multidrug therapy (MDT) in accordance with World Health Organization guidelines. He presented to our service with bilateral ulnar neuritis with no response to prednisone (1 mg/kg). Right ulnar nerve ultrasound revealed nerve hypoechogenicity, fascicular pattern disorganization, marked fusiform thickening, and a round anechoic area suggestive of intraneural abscess. Intense intraneural power Doppler signal was detected, indicating active neuritis. Intravenous methylprednisolone had a poor response and the patient was submitted to ulnar nerve decompression, which confirmed nerve abscess with purulent discharge during surgery. As the patient weighed more than 40 kg, treatment with a pediatric dose was considered insufficient and adult-dose MDT was prescribed, with improvement of nerve pain and function. Although leprosy is rare in developed countries, it still exists in the USA and it is endemic in many developing countries. Leprosy neuropathy is responsible for the most serious complications of the disease, which can lead to irreversible impairments and deformities. Nerve abscess is an uncommon complication of leprosy and ultrasound can efficiently demonstrate this condition, allowing for prompt treatment. There is scant literature about the imaging findings of nerve abscess in leprosy patients. Radiologists should suspect leprosy in patients with no other known causes of neuropathy when detecting asymmetric nerve enlargement and nerve abscess on ultrasound.

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Authors and Affiliations

  1. Dermatology Division, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário, Av. Bandeirantes 3900, Ribeirão Preto, CEP 14049-900, São Paulo, Brazil

    Helena Barbosa Lugão, Marco Andrey Cipriani Frade & Norma Tiraboschi Foss

  2. Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Nilton Mazzer

  3. Radiology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil

    Marcello Henrique Nogueira-Barbosa

Authors
  1. Helena Barbosa Lugão
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  2. Marco Andrey Cipriani Frade
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  3. Nilton Mazzer
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  4. Norma Tiraboschi Foss
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  5. Marcello Henrique Nogueira-Barbosa
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Correspondence to Helena Barbosa Lugão.

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The authors declare that they have no conflicts of interest.

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Informed consent was obtained from the legal party responsible for the participant included in this study. The Institutional Review Board approved the publication of this case report.

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Lugão, H.B., Frade, M.A.C., Mazzer, N. et al. Leprosy with ulnar nerve abscess: ultrasound findings in a child. Skeletal Radiol 46, 137–140 (2017). https://doi.org/10.1007/s00256-016-2517-1

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  • DOI: https://doi.org/10.1007/s00256-016-2517-1

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