Focal presentation leprosy in a patient with ulnar mononeuropathy in Uruguay

https://doi.org/10.59156/revista.v37i01.491

Abstract

Leprosy, or Hansen disease; is a cronic infectious-contagious illness of slow progression that is caused by the bacillus Mycobacterium Leprae. It continues to be a major health problem in endemic areas and has a great impact on the quality of life of patients who suffer from it. It is currently presented as an infrequent cause of neuropathy in our region, but its diagnostic suspicion and therefore its early treatment have repercussions at the prognostic and functional level. Our goal is to analyze a unique case of Hansen's disease in our country, focusing on the clinical presentation and the medical-surgical approach. We present a patient with progressive weakness of the left hand and a chronic skin lesion at the level of the elbow, whose clinical, neurophysiological and imaging findings were consistent with an ulnar nerve injury due to entrapment in the epitrochlear-olecranon canal. The pathology showed a chronic granulomatous process; then bacilloscopy was performed, which was positive for acid-fast bacilli with positive Hansel staining, making a diagnosis of ulnar mononeuropathy secondary to infection by M. Leprae. Given the severity of the nerve involvement, peripheral nerve surgery with epineurotomy and nerve decompression was performed.
In the case of our patient with ulnar neuropathy secondary to Hansen's disease, decompressive surgery was successful in relieving pain, proving to be a relevant therapeutic option in this type of patient.