Nerve Abscess Research Articles

Bridging Eras in Medicine: Modern Modalities for Diagnosing Historical Lepromatous Nerve Abscesses.

Bridging Eras in Medicine: Modern Modalities for Diagnosing Historical Lepromatous Nerve Abscesses.

Ulnar nerve abscess in lepromatous leprosy: Insights from three cases confirmed via ultrasound imaging

Ulnar nerve abscess in lepromatous leprosy: Insights from three cases confirmed via ultrasound imaging

Role of S-100 immunocytochemistry in diagnosis of pure neuritic leprosy on fine needle aspiration cytology – A series of two interesting cases presented as nerve abscess

Pure neuritic leprosy (PNL) constitutes to 4.2 % of all leprosy cases in India. Histopathology is crucial for the diagnosis of PNL ,but fine needle aspiration cytology (FNAC) is now replacing it, as nerve biopsy is a cumbersome procedure and can lead to neurological deficits. FNAC, a minimally invasive procedure can play a significant role in primary diagnosis of PNL. Apart from the cytomorphological features , using ancillary tests can further improve the diagnostic accuracy of PNL. We present here two cases, who presented with a soft tissue swelling. FNAC attempted from the lesions yielded a necrotic material which on microscopy showed abundant caseous necrosis with epithelioid cell granulomas and there were also few spindle shaped cells of neural morphology seen in clusters as well as scattered in the necrotic background. S-100 immunostaing was attempted which highlighted the neuronal cells confirming the diagnosis of PNL.

Hansen’s Disease with Pure Nerve Involvement and Perineural Abscess Mistaken for Peripheral Nerve Sheath Tumour

Nerve abscess is an infrequently reported complication of leprosy. It is also an uncommon first manifestation of leprosy. In this case, due to the absence of classic signs and symptoms, such as skin lesions, hypoesthesia, and loss of sensation, the swelling was clinically diagnosed as a peripheral nerve sheath tumour on initial presentation. The authors have described an unusual presentation of pure neuritic leprosy that showcased nerve abscess. Clinical presentation was swelling over the medial aspect of the right arm and ulnar aspect of the right forearm, and clawing of the fourth and fifth digits of the right hand, with no signs of inflammation present on the skin surrounding the swelling. Hansen’s disease with pure nerve involvement could not be considered as a differential diagnosis solely based on clinical examination, therefore posing a diagnostic challenge. On ultrasonography, the right ulnar nerve showed diffuse intermittent thickening and a heterogeneously hypoechoic fusiform area with internal echoes at the site of swelling indicating a nerve abscess. These led the authors to the diagnosis of leprosy with perineuronal abscess. Histopathology confirmed the diagnosis by revealing granulomas and acid-fast Hansen’s bacilli. The patient showed dramatic response to surgery, multidrug therapy, and systemic corticosteroids.

Spectrum of neurological involvement in mucormycosis following COVID 19: A single tertiary centre study

Background: This study aims to describe the clinical and imaging spectrum of neurological involvement in rhino-orbital cerebral mucormycosis (ROCM) following COVID. In this observational study, all patients with confirmed COVID associated mucormycosis were recruited. Consecutive patients with neurological signs and symptoms or patients with evidence of neurological involvement based on imaging were evaluated. MRI of brain and paranasal sinuses were done in 3T MRI scanner and evaluated by a radiologist. Results: A total of 182 patients were recruited into the study out of which 72 (39.56%) patients had neurological involvement. The mean age of the patients was 50.31±11.06 (Range: 33-83) years. A male preponderance was noted with 56 (74.67%) patients being male. The commonest symptom reported was unilateral vision impairment and periorbital swelling. Patients were noted to have both fulminant and indolent course of illness. Clinical evidence of neurological and orbital involvement was observed in 33 and 55 patients, respectively. Meningeal involvement (50%) was the commonest imaging finding noted in our study. Other common findings noted were skull- based osteomyelitis (44.44%), cavernous sinus thrombosis (29.17%), intracranial abscess (27.78%), cerebritis (22.22%), infarcts (33.33%), neuritis and intracranial haemorrhage (2.78%). Conclusion: This study reports one of the largest single centre cohorts with neurological findings in COVID associated mucormycosis. COVID associated mucormycosis can present with plethora of neurological manifestations in imaging, such as infarct, intracranial and extracranial abscess, neuritis and nerve abscess, sinus thrombosis that may or may not be accompanied by focal neurological deficit corresponding to the anatomical involvement.

Invasive Optic Nerve Aspergillosis with Intracranial Extension in an Immunocompetent Patient (P10-10.004)

<h3>Objective:</h3> To report on an uncommon case of Invasive Optic Nerve Aspergillosis in an Immunocompetent Patient <h3>Background:</h3> Orbital aspergillosis is an uncommon and life-threatening infection. It often affects immunocompromised individuals but can rarely be seen in immunocompetent patients. We present a case of invasive optic nerve aspergillosis with intracranial extension in an immunocompetent male. <h3>Design/Methods:</h3> Case Report <h3>Results:</h3> 59-year-old man presented with a 6-week history of complete left vision loss and left sided facial pain. He was initially diagnosed with optic neuritis and treated with oral prednisone without resolution of symptoms. Initial work including computed tomography (CT) of the head, magnetic resonance imaging (MRI) of the brain, digital subtraction angiography of the head, fluorescence angiography of the left eye, and temporal artery biopsy were all unremarkable. Optical coherence tomography (OCT) demonstrated mild left optic nerve edema. Due to persistent symptoms, an MRI of the orbits was obtained and revealed left optic nerve diffusion restriction with enhancement along the optic tract, suggesting an abscess. Interval OCT revealed worsening left optic nerve layer thinning. The patient was treated initially treated with ceftriaxone, metronidazole, and vancomycin. The optic nerve abscess was surgically decompressed. Cultures grew Aspergillus fumigatus. He was transitioned to oral isavuconazole for a total of 6 months of antifungal therapy. Repeat head CT one month later revealed skull base osteomyelitis with intracranial extension requiring further surgical debridement. The patient was kept on antifungal therapy. Repeat neuroimaging has been stable but there has been no improvement in his vision. <h3>Conclusions:</h3> Orbital aspergillus is a rare entity and as such is a diagnostic challenge. Multiple surgical debridements in addition to appropriate antifungal therapy may be required as recurrent infections are common. Close interval imaging should be obtained to aid in the initial diagnosis and monitoring of orbital fungal infections. <b>Disclosure:</b> Dr. Gill has nothing to disclose. Dr. Whiting has nothing to disclose. Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD serono. The institution of Dr. Malik has received research support from National MS Society .

ULNAR NERVE ABSCESS - A COMPRESSIVE SENSORY MOTOR NEUROPATHY

Introduction: Leprosy is characterized by a triad of hypoesthetic skin lesions, thickened peripheral nerves, and positive skin smear for Mycobacterium leprae. All peripheral nerve functions (sensory, motor, and autonomic) are disrupted in leprosy. The most severe and widespread impairment is in sensory functions. Varied kinds of leprosy show different patterns of nerve involvement. We would introduce a case report of ulnar nerve abscess Presentation of Case: in 21 years old gentlemen presented with swelling over distal third of right arm with tingling sensation over ulnar division right hand with inability to close right fist since last 1.5 years. In many developing nat Discussion: ions, like India, leprosy continues to be a widespread yet curable cause for peripheral neuropathy. Nerve abscess is an infrequent complication, usually associated with Type 1 reaction mostly in tuberculoid and borderline tuberculoid disease that can lead to irreversible nerve damage and deformities3. Leprosy-associated nerve abscess often requires surgical decompression and drainage of the abscess for possible restoration of nerve function2. We have Conclusion: encountered with a unique case of ulnar nerve abscess presenting as compressive neuropathy, due to external compression of swelling which presented as weakness of right hand. Leprosy is still a common and treatable causes of peripheral neuropathy; meticulous workup is a key factor to achieve prompt results

To Study Utility and Practicality of High-Frequency Ultrasonography to Demonstrate Nerve Involvement in Leprosy

ABSTRACT Background: Nerve examination in leprosy is subjective. There is a paucity of literature on objective methods to evaluate nerve involvement in Leprosy. Aims and Objectives: (1) To measure cross-sectional area (CSA) of nerves and identify echotexural changes in nerves in patients of leprosy by high-frequency ultrasonography (HFUS). (2) To compare HFUS findings in CSA and echotexture of nerves at baseline and after treatment. (3) To compare clinical grading and HFUS grading of nerves before and after treatment. Methods: Both newly diagnosed and treated patients of leprosy were included in the study. Nerve examination was done clinically and clinical grading of nerve thickening was done. Then, thickened nerves were subjected to HUFS to examine CSA (CSA) and echotextural changes. Nerves were also graded by HFUS grading. Parameters such as CSA, echotextural changes, and clinical and HFUS grading were compared before and after completion of treatment. Observations: Sixty-four leprosy patients were studied. Most of the patients in our study were in the third and fourth decade with a male preponderance and the mean age of presentation is 35.75 years. A total of 154 peripheral nerves were studied in 64 leprosy patients. Borderline tuberculoid leprosy (BTH) was the most common type of leprosy. The ulnar nerve was the most commonly imaged nerve followed by the greater auricular nerve. There was a statistically significant difference in CSA of nerves before and after treatment. Only 7 of 23 patients, who were found to have features of neuritis on USG, were clinically symptomatic. Three patients were diagnosed to have nerve abscesses. Conclusion: HFUS appears to be an objective, simple method to evaluate nerve involvement in leprosy. It is also useful to diagnose silent neuritis and nerve abscess. Limitations: All the peripheral nerves were not examined in healthy controls and leprosy patients.

MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis

In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.

Childhood leprosy. A retrospective analysis.

The implications of leprosy detected in a child are numerous. Apart from making it mandatory to search for the source in the family, it indicates continued transmission of the disease in the community and thus poses a great hurdle in achieving the targets laid by World Health Organization (WHO) and National Leprosy Eradication Programme (NLEP) in the direction of leprosy elimination. In spite of an effective treatment and the tireless work of various government and non government organizations, the number of childhood cases have not drastically reduced. Elimination of childhood leprosy needs to get the highest priority, not only because of the physical deformities and disabilities but also because of the psychological trauma it causes due to the social stigma attached to it. So we undertook a retrospective study of 5 years from 2015 to 2020 retrieved from the departmental data involving all diagnosed leprosy cases below 18 years of age and studied their clinical spectrum, histopathology and treatment outcomes. In our study, the mean age at the time of diagnosis was 12.95 years. Borderline tuberculoid was the most common type of leprosy in 61.9% of cases. 19.04% had lepra reactions and 14.6% had deformities in the form of claw hand and nerve abscess. The overall incidence of childhood cases was 17.07% that was much higher in comparison to the national figure of 6.87%, probably owing to the small sample size and as the study was conducted in an endemic area. This study highlights the fact that leprosy, especially in children, appears to be far from the point of elimination and a stringent strategy is required to achieve the goal of its eradication.

Burden of Leprosy Patients at Post-Elimination Stage: Evidence from Bangladesh

Introduction: There has been a marked decline in the prevalence rate of leprosy in Bangladesh, but understanding the current magnitude is important for both the service providers and the community. Therefore, the present study is undertaken to describe the pattern and prevalence of leprosy at post-elimination stage. Materials and Methods: This is a descriptive retrospective cross-sectional study carried out using the register records of patients attending the leprosy clinic in Chittagong Medical College Hospital (CMCH) during the period 2004 and 2019. Results: Among a total of 865 patients, males 631 (72.95%) outnumbered females 234 (27.05%). There were 259 (29.59%) paucibacillary (PB) and 606 (70.05%) multibacillary (MB) cases. Smear positive cases were only 218 (25.20%). Of the 865 patients, 515 (59.54%) were BT, which was higher compared to other forms of leprosy. Four age groups were computed. The calculated age-specific cumulative detection rates showed that the highest case detection was in 26- 40 years group 324 (37.46%) patients. A total of 388 (44.87%) patients developed leprosy reactions and 149 (17.22%) patients presented with grade 2 deformities. The LRs comprised of 212 (24.50%) Type 1 Reaction, 74 (8.55%) Type 2 Reaction and 102 (11.79%) neuritis patients. From all, 865 new leprosy patients only 115 (13.29%) had presented with limb deformity, 61 (7.05%) had a trophic ulcer and 29 (3.35%) patients presented with ocular complication. Among the 115 (13.29%) patients with limb deformity 75 (8.67%) had a claw hand followed by foot drop 20 (2.31%), wrist drop 17 (1.96%) and nerve abscess 3 (0.35%). Conclusions: The study shows that new case detection rate is declining but burden of leprosy in the community has not changed significantly. MB (70.05%) patients with grade 2 deformities (17.22%) are still high. Although leprosy has been eliminated globally on paper, the disease continues to be significant cause of peripheral neuropathy, deformity, disability and disfigurement in some developing countries like Bangladesh. Keywords: Leprosy, Reactions, Deformity, Chittagong, Bangladesh. Read more →

Cytomorphology of periarticular nodular swellings: One year study

Introduction: Periarticular nodular swellings represent one of the common manifestations of a wide variety of non-neoplastic and neoplastic lesions. It poses diagnostic challenge for both the clinicians and pathologists due to overlapping signs and symptoms and nonspecific laboratory findings. FNAC helps in categorizing these lesions as inflammatory, degenerative, benign and malignant and offers an early diagnosis. Aims and Objectives: To categorise different nodular swellings around synovial joints of upper and lower limbs and to study the Cytomorphology of these lesions. Materials and Methods: An observational case study of 100 patients with Periarticular nodules of upper and lower extremities referred to the cytology OPD of GMC, Nagpur Maharashtra, over one-year duration. Results: Commonest lesion found was ganglion cyst in 37% patients, followed by lipoma in 18% patients, epidermal cyst in 13% patients, inflammatory lesions in 11% patients, giant cell tumor of tendon sheath in 8% patients, benign mesenchymal tumors in 7% patients. Other interesting cases included gout in 2% patients, rheumatoid nodule, ochronosis, xanthoma, nerve abscess, synovial sarcoma, chloroma and metastasis of squamous cell carcinoma in 1% each. Keywords: Periarticular nodules, FNAC, Inflammatory, Cytomorphology.

Leprosy patients with deformities at post-elimination stage: The Bangladesh experience.

BackgroundDisability assessment in leprosy patients is a very important factor in the evaluation of the effectiveness of a leprosy elimination program. Little information exists on deformities in leprosy patients in Bangladesh.ObjectivesTo describe the pattern and prevalence of deformities in leprosy patients after leprosy has been declared eliminated from Bangladesh in 1998.MethodsA descriptive retrospective cross‐sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients for the period 2004–2013.ResultsOut of 670 leprosy patients, 213 (31.79%) had deformities. The prevalence of deformity was for grade 1: 92 (43.20%), for grade 2: 121 (56.80%). Among the patients with deformity, males 144 (67.60%) outnumbered females 69 (32.40%). Four age groups were considered. The calculated age‐specific cumulative detection rates showed the highest case detection in >40 years group at 81 (38.02%). The rate of children (<14 years) was less at 7 (3.29%). Of the 213 patients with deformity, the borderline tuberculoid patients were totalled 79 (37.08%), which was higher than other forms of leprosy. Among the 121 patients with limb deformity, 57 (8.50%) had claw hand followed by wrist drop 31 (4.63%), foot drop 30 (4.48%). Three (0.45%) had a nerve abscess, 27 (4.02%) had a trophic ulcer and 7 (1.05%) patients had ocular complications.ConclusionThe grade 2 deformities among newly detected leprosy patients were still high. Claw hand was the most common deformity in the upper limbs, whereas foot drop and trophic ulcer were the most common deformities in the lower limbs. Although leprosy according to the World Health Organization has been eliminated globally, the disease continues to be a significant cause of peripheral neuropathy, deformity, disability and disfigurement in some developing countries like Bangladesh.

Clinical Characteristics of Deformities in Leprosy Patients Attending a Tertiary Care Hospital

Background: Disability assessment in leprosy patients is a very important factor in the evaluation of the effectiveness of a leprosy elimination program. Little information exists on deformities of leprosy in Bangladesh. To describe the pattern and prevalence of deformities in leprosy patients after leprosy has been declared eliminated in Bangladesh in 1998.&#x0D; Materials and methods: A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients between the periods 2004 and 2013. No of respondence was 670.&#x0D; Results: Out of 670 leprosy patients 213 (31.79%) had a deformity. The prevalence of deformity was for grade 1: 92 (43.20%) for the grade 2: 121 (56.80%). Among the patients with deformity males 144 (67.60%) out numbered females 69 (32.40%). Four age groups were considered. The calculated age-specific cumulative detection rates showed the highest case detection in &gt; 40 years group at 81 (38.02%). The rate of children (&lt;14 years) was less at 7 (3.29%). Of the 213 patients with deformity, the BT patients counted 79 (37.08%), which was higher than other forms of leprosy. Among the 121 patients with limb deformity 57 (8.50%) had claw hand followed by wrist drop 31 (4.63%), foot drop 30 (4.48%). Three (0.45%) had a nerve abscess, 27 (4.02%) had a trophic ulcer and 7 (1.05%) patients had ocular complications.&#x0D; Conclusion: The grade 2 deformities among newly detected leprosy patients still occur high. Claw hand was the most common deformity in the upper limbs, whereas foot drop and trophic ulcer were the most common deformities in the lower limbs. Although leprosy according to the WHO has been eliminated globally, the disease continues to be a significant cause of peripheral neuropathy, deformity, disability and disfigurement in some developing countries like Bangladesh.&#x0D; JCMCTA 2020 ; 31 (1) : 113-119

Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by SIG Leprosy (IADVL Academy).

Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by SIG Leprosy (IADVL Academy).

Unusually massive ulnar nerve abscess in a leprosy patient; a diagnostic and therapeutic challenge

Unusually massive ulnar nerve abscess in a leprosy patient; a diagnostic and therapeutic challenge

Multiple peroneal nerve abscesses: The first presentation of borderline tuberculoid leprosy

A 53-year-old male presented with multiple swellings over the left leg associated with sensory loss and weak dorsiflexion of the left foot for 4 months. Neurophysiological studies revealed absent sensory and motor action potentials in the left common peroneal nerve. Multiple hypoechoic areas were seen in the subcutaneous plane on ultrasound and were found to be nerve abscesses along the peroneal neurovascular bundle on magnetic resonance imaging of the left leg. Skin biopsy was suggestive of borderline tuberculoid leprosy. He was started on corticosteroids and paucibacillary multidrug therapy. The swelling subsided over the next 1 month, and the motor paralysis improved gradually with treatment.

Nerve abscess in pure neural leprosy mistaken for peripheral nerve sheath tumour with disastrous consequence: what can we learn?

A 34-year-old Indian man presented to an orthopaedician with gradually progressive hypoesthesia affecting his right lower limb and an ipsilateral common peroneal nerve swelling around the knee. The nerve swelling...

Characterization of a yucatan minipig laser-induced choroidal neovascularization model of neovascular age-related macular degeneration

Intracranial complications from acute sinusitis are rare. In particular, intra-optic nerve abscess has not been described. A case report and review of orbital complications from sinusitis is presented here to emphasize the extreme rarity of this clinical entity.Case report and literature review. The patient's pertinent history, clinical findings and radiologic studies are examined.The case of a 33 year old male who was transferred to a tertiary care academic medical center with acute vision loss after developing signs and symptoms consistent with acute sinusitis is presented and reviewed. A computed tomography scan demonstrated pansinusitis with worse severity on the left side. Magnetic resonance imaging revealed a right-sided abscess along the roof of the right sphenoid sinus and the right optic nerve towards the optic chiasm. The patient's clinical exam was consistent with right-sided optic neuropathy. He underwent an emergent functional endoscopic sinus surgery and subsequent right-sided open craniotomy for drainage of an epidural and intracranial abscess involving the right optic nerve, chiasm, and optic tract. The sinusitis was odontogenic in origin. The patient was treated for six weeks with IV ceftriaxone, penicillin and metronidazole and transitioned to five months of PO amoxicillin. At 3-month follow-up, the patient had no evidence of sinusitis and stable ophthalmologic findings.The occurrence of an intra-optic nerve abscess is a rare but possible sequela of acute sinusitis. A multidisciplinary approach involving otolaryngology, neurosurgery, ophthalmology, neuroradiology and infectious diseases is paramount. Surgery and antibiotic therapy is the standard of care.

Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst?

AIMTo highlight the salient magnetic resonance imaging (MRI) features of the intraneural ganglion cyst (INGC) of various peripheral nerves for their precise diagnosis and to differentiate them from other intra and extra-neural cystic lesions.METHODSA retrospective analysis of the magnetic resonance (MR) images of a cohort of 245 patients presenting with nerve palsy involving different peripheral nerves was done. MR images were analyzed for the presence of a nerve lesion, and if found, it was further characterized as solid or cystic. The serial axial, coronal and sagittal MR images of the lesions diagnosed as INGC were studied for their pattern and the anatomical extent along the course of the affected nerve and its branches. Its relation to identifiable anatomical landmarks, intra-articular communication and presence of denervation changes in the muscles supplied by involved nerve was also studied.RESULTSA total of 45 cystic lesions in the intra or extraneural locations of the nerves were identified from the 245 MR scans done for patients presenting with nerve palsy. Out of these 45 cystic lesions, 13 were diagnosed to have INGC of a peripheral nerve on MRI. The other cystic lesions included extraneural ganglion cyst, paralabral cyst impinging upon the suprascapular nerve, cystic schwannoma and nerve abscesses related to Hansen’s disease involving various peripheral nerves. Thirteen lesions of INGC were identified in 12 patients. Seven of these affected the common peroneal nerve with one patient having a bilateral involvement. Two lesions each were noted in the tibial and suprascapular nerves, and one each in the obturator and proximal sciatic nerve. An intra-articular connection along the articular branch was demonstrated in 12 out of 13 lesions. Varying stages of denervation atrophy of the supplied muscles of the affected nerves were seen in 7 cases. Out of these 13 lesions in 12 patients, 6 underwent surgery.CONCLUSIONINGC is an important cause of reversible mono-neuropathy if diagnosed early and surgically treated. Its classic MRI pattern differentiates it from other lesions of the peripheral nerve and aid in its therapeutic planning. In each case, the joint connection has to be identified preoperatively, and the same should be excised during surgery to prevent further cyst recurrence.