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Comment & Response
May 17, 2016

Leprosy as a Cause of Distal Symmetric Polyneuropathy—Reply

Author Affiliations
  • 1Department of Neurology, University of Michigan, Ann Arbor
  • 2Department of Neurology, University of Pennsylvania, Philadelphia
JAMA. 2016;315(19):2123-2124. doi:10.1001/jama.2016.1118

In Reply We agree with Dr Brown that leprosy should be considered as a cause of peripheral neuropathy in patients living in countries where leprosy is endemic and those who have emigrated from those areas, particularly because it is treatable with multidrug antimycobacterial treatment. A mononeuropathy is the most common presentation of leprosy, but lepromatous leprosy can present with more widespread involvement mimicking a distal symmetric polyneuropathy. However, the incidence of leprosy in the United States in 2010 was only 0.0001%.1 The table of causes of distal symmetric polyneuropathy in our article was meant to focus on common causes of polyneuropathy that would present to primary care physicians in the United States. In that context, leprosy remains a rare cause of polyneuropathy, much less common than any of the other conditions listed. For primary care physicians, the focus should remain on evaluating patients for common causes such as diabetes, prediabetes, alcohol abuse, and inherited conditions. The clinical history, including an in-depth alcohol and family history, and the neurologic examination are the most important components of the polyneuropathy evaluation.2 Routine laboratory evaluations should include complete blood cell count, comprehensive metabolic panel, glucose tolerance test, vitamin B12 level, and serum protein electrophoresis with immunofixation.3

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