Annular Erythematous Plaque on the Right Hand

Abstract

Leprosy is an infectious disease primarily involving the skin and peripheral nerves. Most important consequences of leprosy are due to nerve involvement. Neuritis is defined as inflammation of the nerves. The terms neuropathy and neuritis are used interchangeably. Neuritis is defined as pain in the neuro-anatomical area but in conjunction with motor impairment and/or sensory signs in the correspondent nerve, in addition to confirmed demyelinating signs demonstrated in the electrophysiological examination results. Neuropathic pain is defined as pain distribution in a neuro-anatomically plausible area with confirmed negative or positive sensory signs (i.e., hypoesthesia, hyperesthesia, hypoalgesia, hyperalgesia, or allodynia). Neural pain is a common complaint when a leprosy patient seeks medical consultation. Neuropathy in leprosy starts with the entry of Mycobacterium leprae into the Schwann cells of the small nerve fibers. Clinical examination focusing on the enlargement of peripheral nerves and also the triggered pain by nerve palpation are the clinical signs to predict neuritis. A detailed clinical examination is needed to identify the signs, which can otherwise be missed if the only presenting complaint of the patient is a vague neurological symptom. We hereby present a case who presented with such a trivial neurological symptom which on further clinical examination and evaluation revealed the presence of Hansen’s disease. The relevance of clinical examination giving importance to signs is what is being highlighted.