Presentation
Histopathologically proven case of lepromatous leprosy under treatment for the last 4 months. Complaining of left posterior medial elbow region pain and swelling for 3 days.
Patient Data
Photograph showing skin lesions involving posterior medial elbow region.
There is diffuse soft tissue swelling involving medial aspect of elbow. There is no joint effusion. There is no bony abnormality.
Ulnar nerve shows diffuse thickening, hypoechogenesity from proximal mid arm to proximal forearm level. Thickening is maximum just before the cubital tunnel. There is an hypoechoic avascular area in maximally thickened nerve segment.
There is a diffusely thickened, hypoechoechoic cutaneous nerve in the medial elbow. This nerve disappears/joins subcutaneous soft tissue inflammatory hypoechoic area. There are few mobile echoes in this soft tissue inflammatory area. There is local vascularity.
There is no elbow effusion.
Intra-operative photos of ulnar nerve abscess.
Case Discussion
A known case of leprosy presents with elbow pain and swelling for a few days. Ultrasound findings suggested thickened ulnar and a cutaneous nerve along with subcutaneous inflammation. Surgical exploration revealed subcutaneous abscess extending into the ulnar nerve and the cutaneous nerve. Nerve abscesses are an uncommon complication of leprosy.
Intra-operative photos courtesy of the operating surgeon, Dr Niraj I. Patel.
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