71-year-old man with numbness and angiomatous lesions on the dorsum of both hands: unusual manifestation of lepra
DOI:
https://doi.org/10.29176/2590843X.1879Keywords:
Cutaneous dysesthesia, Multibacillary leprosy, Pure neural leprosy, Venous hemangiomaAbstract
We studied a 71-year-old man with diffuse brown pigmentation on the back of both hands, 20 years of evolution. For 6 months he had been numb in both hands, predominantly on the left, an alteration that extended to the fingers and the inner edge of the wrist. There were no skin lesions. Pure neural leprosy was suspected. Thickening of the left ulnar nerve was detected. An electromyography showed a decrease in the velocity of sensory conduction of the radial nerve and the left median which were interpreted as being of compressive origin. Biopsy of the left hand showed extensive dermal hemangioma and numerous small deep nerves surrounded by discrete lymphocytic infiltrate. All contained a good number of resistant acid-alcohol bacilli. Venous hemangioma and pure neural multibacillary leprosy were diagnosed. Treatment was started with polychemotherapy, with onset of type 1 reaction, which was remitted with steroid treatment. He is now considered cured of his Hansen disease. He is an interesting patient because of the prominence of the angiomatous reaction and the clinical persistence in the diagnosis of leprosy due to the numbness of the hands, even if there were no skin lesions. The clinical-pathological correlation allowed us to carefully review the neural changes of the biopsy and confirm the diagnosis of pure neural leprosy. All leprosy is neural from its beginning and when it remains located in the nerve trunks and skin nerves it has pure neural leprosy, difficult to diagnose and which represents 1% of the 300 new cases diagnosed annually in Colombia.
Author Biographies
María Lucia Hernández Valenzuela, Centro Dermatológico Federico Lleras Acosta
Médica interna, Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E. Universidad de La Sabana.
Gerzaín Rodríguez Toro, Centro Dermatológico Federico Lleras Acosta
Docente y consultor en Enfermedades Infecciosas y Tropicales de la Piel. Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E - CDFLLA
Caroll Cuevas-G., Centro Dermatológico Federico Lleras Acosta
Médica interna, Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E. Fundación Universitaria Sanitas.
María Paula Morales-M, Centro Dermatológico Federico Lleras Acosta
Docente y consultor en Enfermedades Infecciosas y Tropicales de la Piel. Hospital Universitario Centro Dermatológico Federico Lleras Acosta E.S.E - CDFLLA.
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Copyright (c) 2025 María Lucia Hernández Valenzuela, Gerzaín Rodríguez Toro, Caroll Cuevas-G., María Paula Morales-M
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