Leprosy mailing list – September 27th, 2006
Ref.: Request
of advice about treatment of ENL reaction
From: Strahm
S., Guinea, West Africa
(Kindly
forward your messages directly to Dr Strahm <stefan.strahm@sam-ame.org>.
I will be out of the office till October 6th - S. Noto)
Dear Dr Noto,
I am seeking
advice for a leprosy patient from Guinea, West Africa. He presented in
April 2004 at our hospital with MB leprosy (many hypopigmented patches
with loss of sensation, no nerve damage). BI was 4+ 3+ 4+. We started
MB treatment. Two months
later, he developed a type II reaction (ENL) with painful subcutaneous
nodules that we treated with Prednisolone 40 mg/d and Clofazimine 300
mg/d. Prednisolone has
subsequently been reduced, but every time arriving at 10, 15 or 20 mg,
there was a relapse of ENL that needed an increase in Prednisolone
dosage. In September
2005, he received a treatment of Thalidomide, but three months later,
a new relapse occurred. Over the last two and a half year, our patient
has suffered of at least 10 ENL episodes, the latest in August 2006. BI is now down to 1+ 2+ 1+.
The actual treatment is Prednisolone 10 mg/d and Clofazimine 200 mg/d.
What can be done for our patient to stop ENL and to reduce and finally
stop Prednisolone? Many thanks in advance for all advise.
Yours sincerely,
Dr Stefan Strahm
