A 45-year-old man with borderline lepromatous leprosy completes multidrug therapy with resolution of skin lesions. At follow-up he reports new numbness of both feet, but examination shows no skin lesions, no tenderness or swelling of nerves, and no history of reaction. Nerve conduction studies confirm bilateral motor and sensory loss. This presentation is best described as:

• A Type 2 lepra reaction
• B Relapse of multibacillary leprosy
• C Lucio phenomenon
• D Silent neuropathy ✓

Explanation

Silent neuropathy is the insidious development of nerve damage without skin lesions, nerve tenderness, or an overt reaction episode, occurring before, during, or even after completion of MDT, particularly in multibacillary disease. Because there is no painful warning, patients may present late with established sensory or motor loss, making regular nerve function testing essential during follow-up. Type 2 reaction features ENL nodules, Lucio phenomenon is a necrotising vasculitis of diffuse lepromatous leprosy, and relapse would show reappearance of skin lesions with rising bacillary index.

Reference: IAL Textbook of Leprosy, 2nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.