Leprotic neuropathy misdiagnosed as chronic inflammatory demyelinating polyneuropathy

Leprosy is a disease characteristically involving the skin and peripheral nerves. Leprosy is diagnosed typically by observation of representative skin lesions and the presence of acid-fast bacilli (AFB) in a skin smear or a skin biopsy; deepnerve biopsies such as a sural nerve biopsy are not routine procedures. Therefore, very few reports of sural nerve biopsies that yield a pathologic finding of leprosy are available; moreover, electron microscopic studies are still rarer. A nerve conduction study (NCS) and sural nerve biopsy are the gold standards for the diagnosis of chronic inflammatory polyneuropathy (CIDP). NCS findings that indicate leprosy are known as mononeuropathy pattern or mononeuritis multiplex pattern and these findings distinguish leprosy from demyelinating polyneuropathies such as CIDP. In non-endemic areas such as Korea, leprosy is not the most likely diagnosis to account for subacute peripheral nerve lesions. We report a case of lepromatous leprosy neuropathy that was misdiagnosed as CIDP after a nerve conduction study and a sural nerve biopsy.