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Therapeutic Dilemma of Refractory Erythema Nodosum Leprosum

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  • 1 Department of Leprosy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China.
  • | 2 Department of Therapy, Shanghai Dermatology Hospital, Shanghai, People's Republic of China.

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

* Address correspondence to Zhichun Jing, Department of Leprosy, Shanghai Dermatology Hospital, No. 1278 Bao De Road, Shanghai 200443, People's Republic of China. E-mail: 35476451@qq.com† These authors contributed equally to this work.

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.

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