Complications
The common paralytic disabilities in leprosy are claw hand, foot drop, lagophthalmos, and wrist-drop. Sensory loss over the extremities leads to misuse of the affected limb, with resultant ulceration and infection and, ultimately, severe deformities and disabilities. Most of the disabilities occur before a patient is diagnosed. Therefore, the most cost-effective method to prevent disabilities is early detection and prompt treatment with multidrug therapy, including proper management of neuritis associated with leprosy reactions.[52]
The eye may be damaged by direct bacillary invasion or by nerve damage. People with leprosy may develop ocular complications, such as corneal ulceration, iridocyclitis, and lagophthalmos. Corneal ulceration may result from corneal anesthesia or from paralysis of the eyelids. Iridocyclitis is one of the most important causes of blindness in leprosy and therefore should be treated promptly with mydriatics and anti-inflammatory drugs. Patients with lagophthalmos must protect their eyes by use of goggles or sunglasses. Frequent use of artificial tear drops during the day and ointments or oily drops at night is advocated.
Lymph glands may be enlarged and painless with the consistency of soft rubber, particularly the femoral, inguinal, and epitrochlear glands, but occasionally one or more glands become very swollen and tender as part of a reactional state.
The reticuloendothelial elements of the abdominal viscera are invaded by bacilli, especially in the spleen and liver, and the red marrow is similarly invaded.
Lymphedema of the lower legs may occur, giving rise to elephantiasis in neglected cases.
Glomerulonephritis, interstitial nephritis, and pyelonephritis may occur. Renal amyloidosis is a prevalent complication in some geographic areas but is uncommon in others; it appears to be related to the severity and frequency of erythema nodosum leprosum.
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