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)