The use of bone scintigraphy to detect active Hansen's disease in mutilated patients

Mutilation of extremities was very frequent in patients affected by leprosy in the past; although it is now much less common, it is still seen, mainly in patients with long-term disease. In general, mutilation of the nose and ears is caused by the bacillus and mutilation of the hands and feet a cons equence of chronic trauma. Leprosy must be chronically treated and any deci sion to interrupt therapy is based on laboratory tests and biopsy. Scintigr aphy is a non-invasive procedure which could be of great value in to determ ining disease activity. We studied eight patients (five males and three fem ales, aged 64-73 years) who presented with mutilation of the nose (2), ear (1), feet (3) or foot and hand (2), Conventional three-phase bone scintigra phy (750 MBq) and X-ray examinations of the affected areas were performed i n all patients. Bone scintigraphy was abnormal in four patients (the presen ce of bacilli was confirmed by biopsy in two of them), and normal in the ot her four. In all patients except for the one with ear mutilation, radiograp hy only showed the absence of bone. We conclude that bone scintigraphy is v ery useful to determine disease activity in cases of mutilation caused by l eprosy. It seems to be superior to conventional radiography and may enable bone biopsies to be avoided.