Nerve Involvement in Leprosy - Pathology, Differential Diagnosis and Principles of Management

Abstract

Nerve damage in non-Iepromatous leprosy and in "reversal" reactions is the result of an immune response to the presence of antigenic material derived from leprosy bacilli within nerves. This immune response damages nerves by in tra-neural epithelioid cell formation, and by compression of Schwann cells due to inflam matory oedema. In lepromatous leprosy the presence of leprosy bacilli induces slow damage to both perineurium and Schwann ceUs. When Erythema Nodosum Le prosum (ENL) develops, associated neuritis is probably brought about by the presence of ENL lesions within the nerves.