# Pure neural leprosy in a child: case report and diagnostic challenges

## TL;DR

A child with pure neural leprosy, diagnosed via anti-PGL-I test and clinical evaluation, shows the challenges of diagnosing leprosy without skin symptoms.

## Contribution

This case report emphasizes the diagnostic value of anti-PGL-I tests in pure neural leprosy without skin lesions.

## Key findings

- The child showed muscle atrophy and sensory loss with no skin involvement.
- Anti-PGL-I test was positive despite negative slit-skin smear for acid-fast bacilli.
- Multidrug therapy improved sensitivity but not all neurological deficits.

## Abstract

Pure neural leprosy (PNL) is infrequent and manifests exclusively in the peripheral nerves without skin involvement, making the diagnosis more complex. We report the case of a 10-year-old child with muscle atrophy and sensory loss, diagnosed through clinical evaluation, grade 2 disability, and a positive anti-PGL-I test. The slit-skin smear (SSS) was negative for acid-fast bacilli. After 12 months of multidrug therapy, esthesiometric sensitivity improved; however, neurological deficits persisted, requiring anti-inflammatory treatment and physiotherapy. This case highlights the importance of early diagnosis and treatment for preventing disabilities. Tools, such as anti-PGL-I tests and imaging, are crucial, particularly in resource-limited settings.