{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:06:16Z","timestamp":1771232776872,"version":"3.50.1"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Introduction<\/jats:title><jats:p>Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Objective<\/jats:title><jats:p>This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Methods<\/jats:title><jats:p>Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Results<\/jats:title><jats:p>Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT.<\/jats:p><\/jats:sec><jats:sec id=\"sec005\"><jats:title>Discussion<\/jats:title><jats:p>The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0010070","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T18:34:58Z","timestamp":1641926098000},"page":"e0010070","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Follow-up assessment of patients with Pure Neural Leprosy in a reference center in Rio de Janeiro\u2014Brazil"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-6065","authenticated-orcid":true,"given":"Izabela Jardim Rodrigues","family":"Pitta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-8760","authenticated-orcid":true,"given":"Mariana de Andrea Vilas-Boas","family":"Hacker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ligia Rocha","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2661-1945","authenticated-orcid":true,"given":"Clarissa Neves","family":"Spitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-1203","authenticated-orcid":true,"given":"Robson Teixeira","family":"Vital","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Maria","family":"Sales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio Luiz Gomes","family":"Antunes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Euzenir Nunes","family":"Sarno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcia Rodrigues","family":"Jardim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"issue":"2","key":"pntd.0010070.ref001","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.inhe.2011.09.006","article-title":"Nerve damage in leprosy: A continuing challenge to scientists, clinicians and service providers.","volume":"4","author":"DN Lockwood","year":"2012","journal-title":"Int Health [Internet]"},{"issue":"3","key":"pntd.0010070.ref002","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1489\/0020-7349(2004)72<284:PNLIIA>2.0.CO;2","article-title":"Pure neuritic leprosy in India: An appraisal","volume":"72","author":"B Kumar","year":"2004","journal-title":"Int J Lepr Other Mycobact Dis"},{"issue":"7","key":"pntd.0010070.ref003","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/s00415-003-1081-5","article-title":"Criteria for diagnosis of pure neural leprosy","volume":"250","author":"MR Jardim","year":"2003","journal-title":"J Neurol"},{"issue":"1","key":"pntd.0010070.ref004","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.clindermatol.2015.10.018","article-title":"Assessing nerves in leprosy.","volume":"34","author":"JA Garbino","year":"2016","journal-title":"Clin Dermatol [Internet]"},{"issue":"3","key":"pntd.0010070.ref005","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1002\/brb3.40","article-title":"Progression of leprosy neuropathy: A case series study","volume":"2","author":"RT Vital","year":"2012","journal-title":"Brain Behav"},{"key":"pntd.0010070.ref006","first-page":"246","volume":"107","author":"SLG Antunes","year":"2012","journal-title":"Histopatologiahansen"},{"issue":"3","key":"pntd.0010070.ref007","doi-asserted-by":"crossref","first-page":"232","DOI":"10.47276\/lr.76.3.232","article-title":"Role of PGL-I antibody detection in the diagnosis of pure neural leprosy.","volume":"76","author":"MR Jardim","year":"2005","journal-title":"Lepr Rev"},{"issue":"3","key":"pntd.0010070.ref008","first-page":"255","article-title":"Classification of leprosy according to immunity. 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