Leprosy
Mailing List – July 24th, 2007
Ref.:
Request of advice about treatment of recurrent ENL reaction
From: Gajadeera S., Colombo,
Sri Lanka
Dear
Dr. Noto,
I am Dr. Susil Gajadeera working in Central
Leprosy Clinic, Room 21, OPD, National Hospital of Sri Lanka, Colombo
8. I am looking for
advice about a patient of ours.
This patient is a 22 years old unmarried girl. For the first time she
reported to Central Leprosy Clinic at Colombo on 26th August 2004. On admission she had several
patches all over the body, mainly upper and lower limbs. She had thickened left and
right ulnar nerves. On
same day her skin smear was done it was BI +4; MI 10%. She started treated with
MDT MB.
On 27.09.2004 she developed low HB count (9.4g). We investigated her and
revealed she had dapsone hypersensitivity. She was given MDT without
dapsone combined with folic acid.
She has completed here 6 doses of MDT (because she was involved
in UMDT programme).
After completion of 6 months of therapy 4.10.2005 she
developed erythematous nodules all over the body. The nodules were very painful. It was an ENL reaction which
was treated with WHO regime of prednisolone. She completely recovered with
prednisolone. 28.11.2005 she developed severe aches and pains, fever
and joint pain? ENL. Treated again with WHO regime
she recovered again.
Then 17.01.2006 again she developed joint swelling. At that time we have to
increase prednisolone 60 mg. per day and gradually reduced. Once prednisolone dose was
reduced less than 20 mg. she developed joint swelling and body
aches and pain and fever.
Now she has developed side effects of prednisolone. Therefore please advise me how
to manage this patient.
Thanking
you very much.
Dr. Gajadeera
