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Therapeutic Dilemma of Refractory Erythema Nodosum Leprosum
Jianyu Zhu
Jianyu Zhu
Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China.
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Degang Yang
Degang Yang
Department of Therapy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China.
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Chao Shi
Chao Shi
Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China.
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Zhichun Jing
Zhichun Jing
Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China.
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Erythema nodosum leprosum (ENL), also known as type II leprosy reaction, is a severe immune-mediated complication of multibacillary leprosy. For ENL, corticosteroids and thalidomide are the mainstays of treatment. Other immunosuppressants, such as clofazimine, cyclosporine, and azathioprine have also been used. Although most patients with ENL respond well to conventional treatments, a small number are refractory to these therapies and have severe morbidity or mortality. We report the case of a 24-year-old man with refractory ENL treated with high-dose corticosteroids for 15 months. The patient developed steroid-dependence and serious adverse effects, and died of an intracranial infection.
Author Notes
Authors' addresses: Jianyu Zhu, Chao Shi, and Zhichun Jing, Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, China, E-mails: 155284144@qq.com, sc_mac@163.com, and 35476451@qq.com. Degang Yang, Department of Therapy, Shanghai Dermatology Hospital, Shanghai, China, E-mail: ydg007@aliyun.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization (WHO), 2014. Global leprosy update, 2013; reducing disease burden. Wkly Epidemiol Rec 89: 389–400.
-
2.
Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, Lockwood DN, 2006. Clinical course of erythema nodosum leprosum: an 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg 74: 868–879.
-
3.
Manandhar R, LeMaster JW, Roche PW, 1999. Risk factors for erythema nodosum leprosum. Int J Lepr Other Mycobact Dis 67: 270–278.
-
4.
World Health Organization (WHO), 1998. Expert Committee on Leprosy. Technical Report series 874. Geneva, Switzerland: WHO.
-
5.
Walker SL, Waters MF, Lockwood DN, 2007. The role of thalidomide in the management of erythema nodosum leprosum. Lepr Rev 78: 197–215.
-
6.
Van Veen NH, Lockwood DN, van Brakel WH, Ramirez J Jr, Richardus JH, 2009. Interventions for erythema nodosum leprosum. Cochrane Database Syst Rev 3: CD006949.
-
7.
Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL, 2006. The continuing challenges of leprosy. Clin Microbiol Rev 19: 338–381.
-
8.
Ramien ML, Wong A, Keystone JS, 2011. Severe refractory erythema nodosum leprosum successfully treated with the tumor necrosis factor inhibitor Etanercept. Clin Infect Dis 52: e133–e135.
-
9.
Moghadam-Kia S, Werth VP, 2010. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol 49: 239–248.
-
10.
Motta ACF, Pereira KJ, TarquĂnio DC, Vieira MB, Miyake K, Foss NT, 2012. Leprosy reactions: coinfections as a possible risk factor. Clinics 67: 1145–1148.
-
11.
Sugumaran DS, 1998. Leprosy reactions: complications of steroid therapy. Int J Lepr Other Mycobact Dis 66: 10–15.
-
12.
Walker SL, Lebas E, Doni SN, Lockwood DN, Lambert SM, 2014. The mortality associated with erythema nodosum leprosum in Ethiopia: a retrospective hospital-based study. PLoS Negl Trop Dis 8: e2690.
-
13.
Davis SV, Shenoi SD, Balachandran C, Pai SB, 2002. A fatal case of erythema necroticans. Indian J Lepr 74: 145–149.
-
14.
De Souza JN, Machado PR, Teixeira MC, Soares NM, 2014. Recurrence of Strongyloides stercoralis infection in a patient with Hansen's disease: a case report. Lepr Rev 85: 58–62.
-
15.
Arunthathi S, Ebenezer G, Daniel E, Sugumaran ST, 2001. Nocardia farcinica pleuritis in a lepromatous patient with severe necrotizing reaction: an unusual presentation. Int J Lepr Other Mycobact Dis 69: 104–107.
-
16.
Walker SL, Balagon M, Darlong J, Doni SN, Hagge DA, Halwai V, John A, Lambert SM, Maghanoy A, Nery JA, Neupane KD, Nicholls PG, Pai VV, Parajuli P, Sales AM, Sarno E, Shah M, Tsegaye D, Lockwood DN, 2015. ENLIST 1: an international multi-centre cross-sectional study of the clinical features of erythema nodosum leprosum. PLoS Negl Trop Dis 9: e0004065.
-
17.
Mesaros N, Nordmann P, Plésiat P, Roussel-Delvallez M, Van Eldere J, Glupczynski Y, Van Laethem Y, Jacobs F, Lebecque P, Malfroot A, Tulkens PM, Van Bambeke F, 2007. Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium. Clin Microbiol Infect 13: 560–578.
-
18.
Driscoll JA, Brody SL, Kollef MH, 2007. The epidemiology, pathogenesis and treatment of Pseudomonas aeruginosa infections. Drugs 67: 351–368.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 621 | 347 | 32 |
| Full Text Views | 488 | 13 | 0 |
| PDF Downloads | 236 | 15 | 0 |