Greater Auricular Neuropathy in Hansen’s Disease

A 28-year-old Indian man presented with painless and progressive swelling on the right side of his neck for the past 2 years. He denied a history of neck injury, prolonged fever, loss of appetite or weight, skin rashes, or diabetes mellitus. Examination revealed a cord-like, nontender swelling on the right neck (Figure 1A), which could be moved side-to-side. Systemic examination was unremarkable. Blood counts, erythrocyte sedimentation rate, blood sugar, andchest X-raywerenormal.Mantoux testwasnegative. A slit skin smear from the right ear lobe showed a large number of acid fast bacilli in the nerves He refused fine needle aspiration cytology or punch biopsy of the nerve. High-resolution ultrasound revealed diffuse thickening of the right greater auricular nerve (GAN) with diffuse fascicular enlargement (Figure 1B, diameter 4.6 cm; normal 0.14 ± 0.03 cm). Imaging of the left GAN was normal (Figure 1C). Nerve ultrasound and electrophysiological studies of other peripheral nerves (including ulnar nerves) were unremarkable. With multidrug treatment for leprosy, he remained asymptomatic at 3-monthoutpatient visit. Hedid not come for further follow-up.