Leprosy
Mailing List, October 31st, 2008
Ref.: Histoid leprosy
From: Ranawaka R.,
Anuradhapura
,
Sri Lanka
Dear Dr
Salvatore,
Thank you
very much for the clinical experience given by members of the LML
regarding my previous clinical problems (recurrent type I reaction and
nerve abscess). I have
another patient whom I would like expert's opinion on management.
A 46-year-old
woman with borderline lepromatous (BL) leprosy was started on
multibacillary multi-drug therapy (MB-MDT) 15 months ago. When she was on her 6th month
of therapy she developed type I reaction which we treated with
12-weeks oral prednisolone regime. At
the 10th month of MB-MDT she developed painless discrete nodules of
1cm diameter on face and limbs. Skin
biopsy revealed “histoid” leprosy.
We completed
12 MB blister packs, but skin nodules persisted; therefore the
morphological index (MI) was performed, which was 5%. We continued MB blister packs.
After 1 month (13th
month) the MI was 0%. But at
14th month these nodules ulcerated. I
added ofloxacin 400mg daily with MB therapy. Now ulceration healed and some
of the nodules have disappeared.
For how long
it would be safe to continue ofloxacin? Until the lesions are fully
flattened? My plan is to
continue MB treatment for 24 months. How
do assess cure in this patient?
Your opinion
regarding management of this patient will be greatly appreciated.
Kind regards,
Ranthilaka
Ranawaka
Consultant
Dermatologist
Teaching
Hospital
Anuradhapura
Sri
Lanka
