A farmer from rural India presents with progressive asymmetrical weakness and claw hand deformity. Examination reveals thickened ulnar and posterior auricular nerves with complete sensory loss, but the skin shows no lesions whatsoever. Slit-skin smears are negative. What is the diagnosis?
- A Borderline tuberculoid leprosy
- B Histoid leprosy
- C Pure neuritic (polyneuritic) leprosy ✓
- D Indeterminate leprosy
Correct answer: C. Pure neuritic (polyneuritic) leprosy
Explanation
Pure neuritic (polyneuritic) leprosy is seen predominantly in India and involves peripheral nerves without any cutaneous lesion. Patients present with mononeuropathy multiplex, nerve thickening and anaesthetic limbs; nerve biopsy may be needed for confirmation when skin smears are unhelpful. Borderline and indeterminate types always show skin lesions eventually, and histoid leprosy presents as firm cutaneous nodules with a high bacterial index.
Reference: Fitzpatrick's Dermatology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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