Case report:
A 36 years old lady presented with ulcer over anterolateral aspect of
left foot (figure 1a) for duration of 8 months. She was diagnosed as
leprosy from other center and was started on WHO MB-MDT blister pack.
She was under fifth blister pack at the time of presentation to our
center. She had history of decreased sensation over bilateral hands and
feet but there was no history of any cutaneous lesions of leprosy.
Clinical examination showed thickened and non-tender peripheral nerves
(ulnar, radio cutaneous and lateral popliteal) with complete loss of
sensation to temperature (hot/cold), touch and pain over bilateral hands
and feet as per WHO testing sites. There was hypothenar atrophy on right
hand and mobile clawing of little finger on left hand. No cutaneous
lesions suggestive of leprosy were noted.
Slit skin smear was negative. Nerve conduction study revealed
asymmetrical sensory-motor axonal polyneuropathy involving peripheral
nerves of upper limbs and symmetrical sensory involvement on nerves of
lower limbs. The diagnosis of Pure Neuritic Hansen’s Disease with grade
II disability of bilateral hands and left foot and grade I disability of
right foot was made and patient was continued WHO MB-MDT with
immobilization of feet and closed dressing of trophic ulcer. The ulcer
was healed completely in 4 weeks. (Figure 1b)