Siham Boularbah1*, Hanane Baybay1, Sabrina Oujdi1, Zakia Douhi1, Meryem Soughi1, Mernissi Fatima Zahra1
1Department of Dermatology, CHU Hassan II, Fez, Morocco
*Correspondence author: Boularbah Siham, Department of Dermatology, CHU Hassan II, Fez, Morocco; Email: [email protected]
Published Date: 16-07-2023
Copyright© 2023 by Siham B, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Clinical Image
Erythema Nodosum Leprosum (ENL) is considered a distinct entity from the reaction state of leprosy, it is a complication observed during lepromatous leprosy, its occurrence before any antibacillary treatment is possible, but relatively rare in our practice [1].
Corticosteroid therapy is considered the reference treatment in almost all countries affected by this disease where thalidomide is not available. However, thalidomide offers an effective alternative to corticosteroid therapy, allows better long-term control and avoids the adverse effects of prolonged corticosteroid therapy [2]. We report a case of ENL in Lepromatous Leprosy (LL) resistant to conventional treatment then treated with thalidomide with good improvement.
29-year-old patient treated for lepromatous leprosy in October 2017 by polychemotherapy with poor treatment compliance, the patient was lost to sight for 8 months, consulted for a diffuse rash, progressing by flares for a year, calmed down by taking oral corticosteroids in an anarchic way. On examination, low grade fever was noted at 38°C, a diffuse nodular eruption on the extension faces of the forearms, thighs, legs, thorax and back painful on palpation independent of specific lepromatous lesions, hyperalgesic multineuritis with motor and sensory disorders in the lower limbs, bilateral gonoarthritis, bacterial conjunctivitis and orchiepididymitis.
Biological examination objectified hyperleukocytosis, inflammatory syndrome, joint puncture in favor of septic arthritis. Bacilloscopy showed BAAR at 4+. The patient was put under acetylsalicylic acid 2 g per day and clofazimine without improvement then thalidomide was started at a dose of 400 mg per day for a period of twelve months with an improvement. After 24 months the patient had no more ENL flare-ups (Fig. 1).
Figure 1: (a) Diffuse nodular eruption at the extremities (right); (b) Complete improvement after treatment with thalidomide (left).
Keywords: Bacilloscopy; Erythema Nodosum Leprosum; Lepromatous Leprosy; Corticosteroid Therapy
Consent
The examination of the patient was conducted according to the Declaration of Helsinki principles.
Conflict of Interest
The authors have no conflict of interest to declare.
References
- Ramesh MB , Tanvi PV. What is new in the pathogenesis and management of erythema nodosum leprosum. Indian Dermatol Online J. 2020;11:482-92.
- Perpétua do SSC, Lucas RF, Thayne W K, Egon L RD, Lavínia SF, Fernanda SLV. Erythema nodosum leprosum: update and challenges on the treatment of a neglected condition. Acta Trop. 2018;183:134-41.
Article Type
Clinical Image
Publication History
Received Date: 21-06-2023
Accepted Date: 09-07-2023
Published Date: 16-07-2023
Copyright© 2023 by Siham B, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Siham B, et al. Erythema Nodosum Leprosum and Thalidomide: How Effective? J Dermatol Res. 2023;4(2):1-2.
Figure 1: (a) Diffuse nodular eruption at the extremities (right); (b) Complete improvement after treatment with thalidomide (left).
