Leprosy as a Cause of Distal Symmetric Polyneuropathy.

Abstract

EnglishThe review article on distal symmetric polyneuropathy by Dr Callaghan and colleagues1 did not address leprosy (Hansen disease), which may be the most common treatable peripheral nerve disorder worldwide.2 The major features of leprosy are anesthetic skin lesions, neuropathy, and positive skin smears for Mycobacterium leprae bacilli. The lepromatous form of leprosy is a slow, progressive, widespread disease of skin and nerves manifesting as bilateral, symmetrical, distal polyneuropathy. The tuberculoid and borderline forms of leprosy typically cause focal mononeuropathies and polyneuropathies. If untreated, the associated neuropathy causes deformity and permanent disability; however, early treatment is associated with good outcomes. EnglishWe agree with Dr Brown that leprosy should be considered as a cause of peripheral neuropathy in patients living in countries where leprosy is endemic and those who have emigrated from those areas, particularly because it is treatable with multidrug antimycobacterial treatment. A mononeuropathy is the most common presentation of leprosy, but lepromatous leprosy can present with more widespread involvement mimicking a distal symmetric polyneuropathy. However, the incidence of leprosy in the United States in 2010 was only 0.0001%.1 The table of causes of distal symmetric polyneuropathy in our article was meant to focus on common causes of polyneuropathy that would present to primary care physicians in the United States. In that context, leprosy remains a rare cause of polyneuropathy, much less common than any of the other conditions listed. For primary care physicians, the focus should remain on evaluating patients for common causes such as diabetes, prediabetes, alcohol abuse, and inherited conditions. The clinical history, including an in-depth alcohol and family history, and the neurologic examination are the most important components of the polyneuropathy evaluation.2 Routine laboratory evaluations should include complete blood cell count, comprehensive metabolic panel, glucose tolerance test, vitamin B12 level, and serum protein electrophoresis with immunofixation