{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:36:58Z","timestamp":1756190218811,"version":"3.40.5"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T00:00:00Z","timestamp":1637280000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The diagnosis of pure neural leprosy is more challenging because patients share characteristics with other common pathologies, such as ulnar compression, which should be taken into consideration for differential diagnosis. In this study, we identify ulnar nerve conduction characteristics to aid in the differential diagnosis of ulnar neuropathy (UN) in leprosy and that of non-leprosy etiology. In addition, we include putative markers to better understand the inflammatory process that may occur in the nerve. Data were extracted from a database of people affected by leprosy (leprosy group) diagnosed with UN at leprosy diagnosis. A non-leprosy group of patients diagnosed with mechanical neuropathy (compressive, traumatic) was also included. Both groups were submitted to clinical, neurological, neurophysiological and immunological studies. Nerve enlargement and sensory impairment were significantly higher in leprosy patients than in patients with compressive UN. Bilateral impairment was significantly higher in the leprosy group than in the non-leprosy group. Leprosy reactions were associated to focal demyelinating lesions at the elbow and to temporal dispersion (TD). Clinical signs such as sensory impairment, nerve enlargement and bilateral ulnar nerve injury associated with eletrodiagnostic criteria such as demyelinating finds, specifically temporal dispersion, could be tools to help us decided on the best conduct in patients with elbow ulnar neuropathy and specifically decide if we should perform a nerve biopsy for diagnosis of pure neural leprosy.<\/jats:p>","DOI":"10.1371\/journal.pone.0259804","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T18:34:15Z","timestamp":1637346855000},"page":"e0259804","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["The red flags of ulnar neuropathy in leprosy"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1784-6857","authenticated-orcid":true,"given":"M\u00e1rcia","family":"Jardim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robson T.","family":"Vital","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1504-1553","authenticated-orcid":true,"given":"Ximena","family":"Illarramendi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-8760","authenticated-orcid":true,"given":"Mariana","family":"Hacker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Junqueira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izabela J. R.","family":"Pitta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta O.","family":"Pinheiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Euzenir N.","family":"Sarno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,11,19]]},"reference":[{"key":"pone.0259804.ref001","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"},{"key":"pone.0259804.ref002","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/B978-1-56053-433-4.50032-8","volume-title":"Electrodiagnostic Medicine","author":"D ZM Dumitru","year":"2002","edition":"2"},{"key":"pone.0259804.ref003","article-title":"Isolated median neuropathy as the first symptom of leprosy","author":"RT Vital","year":"2013","journal-title":"Muscle & nerve"},{"issue":"37","key":"pone.0259804.ref004","first-page":"276","article-title":"Significance of electroneurographic parameters in the diagnosis of chronic neuropathy of the ulnar nerve at the elbow","volume":"4","author":"AO Kitzinger HB","year":"2005","journal-title":"Handchir Mikrochir Plast Chir"},{"issue":"2","key":"pone.0259804.ref005","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.ncl.2011.12.003","article-title":"Electrodiagnostic evaluation of ulnar neuropathy and other upper extremity mononeuropathies","volume":"30","author":"Elliot L Dimberg","year":"2012","journal-title":"Neurol Clin"},{"issue":"1","key":"pone.0259804.ref006","first-page":"1","article-title":"Leprosy neuropathy: correlation of clinical and electrophysiological tests","volume":"68","author":"T. R. Brown","year":"1996","journal-title":"Indian J Lepr"},{"issue":"2","key":"pone.0259804.ref007","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/WNP.0b013e31824d969c","article-title":"Ulnar neuropathy in hansen disease: clinical, high-resolution ultrasound and electrophysiologic correlations","volume":"29","author":"L. Bathala","year":"2012","journal-title":"J Clin Neurophysiol"},{"key":"pone.0259804.ref008","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1172\/JCI117251","article-title":"Angiotensin II stimulates extracellular matrix protein synthesis through induction of transforming growth factorbeta expression in rat glomerular mesangial cells","volume":"93","author":"S Kagami","year":"1994","journal-title":"J Clin Invest"},{"key":"pone.0259804.ref009","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.bbi.2006.10.015","article-title":"Cytokine regulation of MMP9 in peripheral glia: Implications for pathological processes and pain in injured nerve","volume":"21","author":"S Chattopadhyay","year":"2007","journal-title":"Brain Behav Immun"},{"issue":"3","key":"pone.0259804.ref010","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1093\/jnen\/nlv027","article-title":"Inflammatory Cytokines Are Involved in Focal Demyelination in Leprosy Neuritis","volume":"75","author":"PR Andrade","year":"2016","journal-title":"J Neuropathol Exp Neurol"},{"key":"pone.0259804.ref011","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.cyto.2018.07.008","article-title":"Leprosy and its reactional episodes: Serum levels and possible roles of omega-3 and omega-6-derived lipid mediators","volume":"112","author":"C. S. De Macedo","year":"2018","journal-title":"Cytokine"},{"key":"pone.0259804.ref012","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3389\/fimmu.2020.00023","article-title":"Cytokine Levels in Neural Pain in Leprosy","volume":"11","author":"DBM Angst","year":"2020","journal-title":"Front Immunol"},{"issue":"3","key":"pone.0259804.ref013","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 and behavior"},{"volume-title":"Manual of nerve conduction velocity and clinical neurophysiology","year":"1994","author":"J. A. DeLisa","key":"pone.0259804.ref014"},{"key":"pone.0259804.ref015","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.clinph.2010.06.025","article-title":"Current Status on Electrodianostic Standards and Guidelines In Neuromuscular Desorders","volume":"122","author":"A Fuglsang-Fredeiksen","year":"2010","journal-title":"Clinical Neurophysiology"},{"issue":"7","key":"pone.0259804.ref016","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1016\/j.clinph.2005.04.003","article-title":"Pathophysiology inferred from electrodiagnostic nerve tests and classification of polyneuropathies. Suggested guidelines","volume":"116","author":"H Tankisi","year":"2005","journal-title":"Clin Neurophysiol"},{"issue":"2","key":"pone.0259804.ref017","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1128\/CMR.19.2.338-381.2006","article-title":"The continuing Challenges of Leprosy","volume":"19","author":"DM Scollard","year":"2006","journal-title":"Clin Microbiol Rev"},{"key":"pone.0259804.ref018","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.coi.2004.05.021","article-title":"Mycobacterium leprae-induced demyelination: a model for early nerve degeneration","volume":"16","author":"A Rambukkana","year":"2004","journal-title":"Current Opinion in Immunology"},{"issue":"3","key":"pone.0259804.ref019","doi-asserted-by":"crossref","first-page":"199","DOI":"10.5935\/0305-7518.19750022","article-title":"Nerve involvement in leprosy\u2014pathology, differential diagnosis and principles of management","volume":"46","author":"JM Pearson","year":"1975","journal-title":"Leprosy review"},{"issue":"3","key":"pone.0259804.ref020","first-page":"347","article-title":"Nerve damage, surgery and rehabilitation in leprosy","volume":"41","author":"H Srinivasan","year":"1990","journal-title":"Trop Med Parasitol"},{"issue":"1","key":"pone.0259804.ref021","first-page":"30","article-title":"Nerves in the arm in leprosy. 2. Pathology, pathogenesis and clinical correlations","volume":"38","author":"DK Dastur","year":"1970","journal-title":"Int J Lepr Other Mycobact Dis"},{"key":"pone.0259804.ref022","unstructured":"Preston D;C and Shapiro B.E. ELECTROMYOGRAPHY AND NEUROMUSCULAR DISORDERS: ISBN: 978-0-323-66180-5 CLINICAL-ELECTROPHYSIOLOGIC-ULTRASOUND CORRELATIONS, Elsevier. 3rd ed. 2021, 402\u2013416."},{"issue":"1","key":"pone.0259804.ref023","first-page":"21","article-title":"Nerve conduction studies in leprosy","volume":"43","author":"JG McLeod","year":"1975","journal-title":"Int J Lepr Other Mycobact Dis"},{"key":"pone.0259804.ref024","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1002\/mus.20022","article-title":"Electrodiagnostic Criteria For Acute And Chronic Inflammatory Demyelinating Polyradiculoneuropathy","volume":"29","author":"P.Y.K VAN DEN BERGH","year":"2004","journal-title":"Muscle Nerve"},{"key":"pone.0259804.ref025","article-title":"Ulnar Neuropathy at the Elbow Associated With Focal Demyelination in the Proximal Forearm and Intraoperative Imaging Correlation","author":"Ahmad R Abuzinadah","year":"2019","journal-title":"Front Neurol"},{"key":"pone.0259804.ref026","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1007\/BF00886875","article-title":"Electro-physiological evaluation of nerves during reactions in leprosy","volume":"243","author":"A.K. Thacker","year":"1996","journal-title":"J Neurol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259804","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T18:34:55Z","timestamp":1637346895000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259804"}},"subtitle":[],"editor":[{"given":"Leila","family":"Harhaus","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,19]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259804","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,11,19]]}}}