“Segmental Necrotizing Granulomatous Neuritis”: A Rare Manifestation of Hansen Disease—Report of 2 Cases

Segmental necrotizing granulomatous neuritis (SNGN) is a rare condition affecting the nerves of Hansen disease patients. This is usually seen as a complication in association with the skin lesions of Hansen disease. Though very rare, it can also be the first presenting symptom of pure neuritic leprosy. We hereby report 2 cases of SNGN—one case of pure neuritic leprosy with initial presentation as SNGN and another, a treated case of borderline tuberculoid leprosy which relapsed with skin lesions and associated SNGN in the peripheral nerve. 1. Introduction Leprosy, the chronic infectious disease caused by M. leprae affects mainly the skin and the peripheral nerves. The disease is endemic in many tropical and subtropical countries but is declining in prevalence as a result of multidrug therapy and improved personal hygiene. The Indian subcontinent, Southeast Asia, sub-Saharan countries in Africa, and Brazil comprise the areas most affected at present [1]. Segmental necrotizing granulomatous neuritis (SNGN) is a rare complication seen in the peripheral nerves of Hansen disease patients. It can develop in association with a skin lesion or may be the initial presentation in pure neuritic leprosy. SNGN is usually associated with borderline tuberculoid leprosy. It can present as a single or multiple nodule/s of varying sizes along the course of a thickened peripheral nerve. In the earlier published literature, this lesion had been reported as nerve abscess. A patient presenting with a linear or nodular thickening of the peripheral nerve with impairment of sensation should always be investigated for Hansen disease even if there is no skin lesions. Early diagnosis of the condition and prompt treatment can cure the disease. Pure neuritic leprosy accounts for 4–8% of all leprosy cases [2]. The incidence of SNGN in pure neuritic leprosy has been estimated as 0.25% of all leprosy patients in the study by Chandi et al. [3]. In some cases, SNGN may be the only clinical manifestation of leprosy [4, 5]. Here, we are reporting 2 cases of segmental necrotizing granulomatous neuritis—one as the initial presentation of pure neuritic form of leprosy and the other as an associated peripheral nerve involvement in a treated and relapsed case of borderline tuberculoid leprosy with skin lesion. 2. Case History 2.1. Case？？1 30-year-old female presented with complaints of a linear cord like thickening in her right leg with numbness in the feet of 3-month duration. On examination, it was confirmed to be thickened superficial peroneal nerve with intermittent tiny nodular swellings