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• Vol.43 No.5
• CLINICA NEUROL, 43: 265−269, 2003
• Vol.43 No.5 contents

Case Report

The painful multiple mononeuropathy of acute onset in the left arm which was diagnosed as leprous neuropathy

Satoko Nakayama, M.D.¹⁾, Yoshikazu Uesaka, M.D.¹⁾, Masanari Kunimoto, M.D.¹⁾, Takashi Mikata, M.D.²⁾, Jun Shimizu, M.D.²⁾ and Norihisa Ishii, M.D.³⁾

¹⁾International Medical Center of Japan, Department of Neurology
²⁾University of Tokyo, Department of Neurology
³⁾Leprosy Research Center, National Institute of Infectious Diseases

A 31-year-old man from Myanmar with leprous neuropathy was reported. The progress of the disease was subacute but the painful symptom at the time of the onset was acute. Multiple mononeuropathy was diagnosed by the biopsy findings of the left superficial radial nerve. He was admitted to our hospital with the complaint of the weakness of his left hand and fingers which were very painful and got worse in several weeks. Motor palsy was observed in his left ulnar, median, and radial nerves, and there was the hypesthesia or anesthesia in his left hand, forearm and the medial side of his left upper arm. On nerve conduction studies, the amplitudes of CMAP and SNAP severely diminished or not detected. The pattern was compatible with multiple mononeuropathy. The biopsy of the left superficial radial nerve was performed. The pathological findings were the destruction of nerve fascicles, replacement of nerve fibers with inflammatory cells, and Mycobacterium leprae was found with the specific stain. These findings confirmed the diagnosis of the leprous neuropathy. Leprous neuropathy is one of the commonest causes of infectious neuropathy in the world, especially in Southeast Asia. These days many foreign workers from that area are staying in Japan, and the chances to see the disease are increasing. We have to recognize leprous neuropathy as a candidate for the multiple mononeuropathy of acute onset with painful dysesthesia similar to vascular neuropathy.

(CLINICA NEUROL, 43: 265−269, 2003)
key words: Hansen's disease, leprous neuropathy, multiple mononeuropathy, superficial radial nerve

(Received: 12-Dec-02)