Nerve abscess in lepromatous leprosy; report of a case, with a review of reports of nerve abscess in Japan.

The so-called nerve abscess, one of the interesting features of leprosy, is recognized to be neither common nor rare in the neural and tuberculoid forms of the disease. On the other hand the condition is exceptional and rare in lepromatous leprosy, but it does occur although there are very few reports of it. Some workers, e. g., Hughes (5), have held that nerve abscess occurs only in tuberculoid leprosy, because of the relatively low reactivity of the tissue in the other forms. In discussing Hughes' paper, however, Muir stated that in India he had seen such lesions in lepromatous cases that probably had begun as of the neural type, and Austin said that he had twice encountered them in operations on lepromatous cases in Fiji. Wade (27), undertaking to obtain further information from these observers, told of two unpublished cases of reactional nature in his own experience. In one instance bilateral ulnar abscesses were found at autopsy, and they were pictured in a monograph by Wade and Rodriguez (29), the only such picture heretofore published. The other example was a biopsy specimen obtained at an operation performed for relief of acute ulnar pain. In both instances the lesions were histologically and bacteriologically lepromatous, not tuberculoid. In reply to the inquiry Austin (1) showed that his observations were entirely clinical, without bacteriological or other examinations. Muir (13) referred specifically to a "C2-N2" case mentioned in a publication by Muir and Chatterji (14), which had multiple nerve abscesses containing pus with abundant acid-fast bacilli. The only case report previous to the present one that is documented by a photomicrograph, to my knowledge, was a brief one by Schujman (21). The patient, negative to lepromin, had no skin lesions but there were two nodules of the ulnar nerves. Sections showed typical lepromatous histology; bacilli were said to be abundant. Wade (28) then called attention to the matter editorially, urging that any such cases should be reported. That suggestion led to the present article.