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Peripheral nerve biopsy: Is it still important for the early diagnosis of neural leprosy?

2021; Medical Association of São Paulo; Linguagem: Inglês

10.5327/1516-3180.410

1806-9460

Isabella Sabião Borges, João Victor Aguiar Moreira, Thales Junqueira Oliveira, Maria Fernanda Prado Rosa, Gabriel Nunes Melo Assunção, Pedro Otávio Rego de Aguiar, Thaciany Soares Ferreira, Leonardo Peixoto Garcia, Glauber Mota Pacheco, Clarice Pereira Sales Oliveira, Gabriela Tomás Alves, Pedro Henrique Pereira Maciel, João Paulo Moreira Fernandes, Alencar Pereira dos Santos, Eustaquio Costa Damasceno, Mateus Barros Bueno, Rafael Lopes de Souza, Leonardo Rivelli Silvestre, Isabela Maria Bernardes Goulart, Diogo Fernandes dos Santos,

Nail Diseases and Treatments

Background: The early recognition of neural impairment in leprosy represents a challenge in clinical practice and peripheral nerve biopsy may be required for diagnostic. Objective: Characterize the epidemiological, clinical, electroneuromyographic, laboratory and histopathological aspects of patients undergoing peripheral nerve biopsy during investigation of primary neural leprosy. Methods: 104 patients with peripheral neuropathy, referred to a national reference center leprosy, were biopsied. All patients had clinical evidence of peripheral neuropathy associated with the absence of skin lesions and were being investigated. Results: Of 104 biopsied, leprosy was confirmed in 89.4%. 66 were classified as primary neural leprosy and 27 as neural relapse or reinfection. All cases confirmed presented asymmetric neural impairment with predominance of sensory symptoms (88.2%), followed by muscular weakness and/or amyotrophy in 44.1% and pain in 34.4%. Neural thickening of one or more nerves was observed in 78.5% of the patients. The biopsied nerves were: ulnar (67.8%), superficial fibular (21.5%), sural (8.6%), radial (1.1%) and deep fibular (1.1%). 29% presented histopathological abnormalities and 4.4% acid fast bacilli. Nerve and superjacent skin qPCR were positive in 49.5% and 24.8% of cases, respectively. The patients with multiple mononeuropathy presented higher frequency of neural thickening (p<0.0001) and histopathological abnormalities (p=0.0077), but lower rates of positivity of ELISA anti-PGL-I (p=0.0100), qPCR in the peripheral blood (p=0.0157), and in the slit skin smear (p=0.0032). Conclusions: Peripheral nerve biopsy is an important tool in the investigation of primary neural cases, contributing to the early diagnosis and reducing diagnostic errors and the need for empirical treatment.