Article
The diagnosis of leprosy among patients with symptoms of peripheral neuropathy without cutaneous lesions: a follow-up study
O diagnóstico de hanseníase neural pura entre pacientes com sintomas de neuropatia periférica: acompanhamento clínico
Registro en:
SKACEL, Michael et al. The diagnosis of leprosy among patients with symptomsof pheripheral neuropathy without cutaneous lesions: a follow-up study. Arquivos de Neuro-Psiquiatria, v. 58, n. 3-B, p.800-807, Sept. 2000.
0004-282X
10.1590/S0004-282X2000000500002
1678-4227
Autor
Skacel, Michael
Antunes, Sérgio Luiz Gomes
Rodrigues, Márcia Maria Jardim
Nery, José Augusto da Costa
Valentim, Vânia da Costa
Morais, Renara Patrícia Braga de
Sarno, Euzenir Nunes
Resumen
Quarenta e quatro pacientes com sinais de neuropatia periférica foram acompanhados no Ambulatório de Hanseníase da Fundação Oswaldo Cruz por período que variou de 4 meses até 4 anos, com o intuito de
confirmar ou afastar o diagnóstico de neuropatia hanseniana. Os sintomas neurológicos apresentados foram hipoestesia (41), parestesia (28), espessamento neural (22), dor nos nervos (20), paresia (20), amiotrofia (8). Dez pacientes dos 44 tiveram o diagnóstico de hanseníase confirmado. A confirmação diagnóstica se deu através da biópsia de áreas hipoestésicas sem lesão dermatológica (3 pacientes), pelo aparecimento de estados reacionais (duas reações reversas e 4 neurites reacionais) e pelo aparecimento de lesão cutânea não reacional característica da forma “borderline” lepromatosa. O acompanhamento clínico regular dos pacientes sem diagnóstico no primeiro exame mostrou ser um método que permitiu o diagnóstico da forma neurítica pura da hanseníase, quando os
métodos objetivos de diagnóstico não confirmarem de imediato a doença. Forty-four patients with neuritic leprosy were individually followed for periods ranging from 4 months to almost 4 years for the purpose of ascertaining the presence and/ or absence of leprosy. The neural symptoms presented were sensory impairment (41), parasthesia (28), nerve enlargement (22), nerve tenderness (20), paresia (20), amyotrophy (8). Leprosy was diagnosed in ten out of the total number of patients studied. Leprosy was confirmed by the appearance of reactional neuritis (4), reversal reaction (2), biopsy of the hypoesthesic area (3) and the appearance of non-reactional cutaneous lesion. We reported an experience in the diagnosis of neuritic leprosy and its most frequent clinical presentation with which clinicians have to be acquainted. We can also state that the clinical follow-up was an effective strategy for the diagnosis of the disease when diagnostic facilities are not available or have not confirmed the diagnosis.