A multibacillary leprosy patient on regular MDT is found on routine assessment to have developed new weakness of wrist dorsiflexion and reduced grip strength, though he reports no pain, no skin reaction, and no fever. Previous monthly assessments were normal. What is this phenomenon called, and why does it demand prompt action?

• A Silent neuropathy, which requires immediate corticosteroids because nerve damage progresses painlessly even during effective MDT ✓
• B Grade 1 reaction, which needs no treatment as function recovers spontaneously
• C Drug-induced neuropathy from dapsone, requiring immediate withdrawal of MDT
• D Relapse of leprosy, requiring a full repeat course of rifampicin-based therapy

Explanation

Silent neuropathy is the development of new nerve damage without pain or overt reaction, detectable only through regular motor and sensory testing of patients, particularly those with multibacillary disease. It can occur even while the patient is taking effective multidrug therapy. Because the patient feels nothing, damage becomes established before presentation, so periodic nerve function assessment and prompt corticosteroid treatment are essential to prevent permanent deformity. Dapsone neuropathy is rare and relapse would show activity of skin lesions with positive bacilli.

Reference: IAL Textbook of Leprosy, 3rd ed.

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