Deep Vein Thrombosis Complicating Recurrent Erythema Nodosum Leprosum

Recurrent erythema nodosum leprosum (ENL) is a type 2 leprosy reaction, which often poses a challenge for the treating physician. Patient may be non-ambulatory due to systemic symptoms like fever, body aches, joint pains, and painful skin lesions. Moreover, drugs like corticosteroids and thalidomide in refractory cases pose an increased risk of deep vein thrombosis (DVT). We have described a case who developed DVT in due course of the treatment.

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Abstract INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.

Use of Validated Severity Scales for Measurement of Lepra Reactions

The need of a validated scale or tool to measure a disease condition, particularity its severity, cannot be over emphasized in clinical research. A validated scale can be used to compare a condition across cultures. Reactions in leprosy continue to be important causes of morbidity both systematic as well as local in the form of pain and disabilities. Measurement of their severity may be helpful in rationalizing their proper management. In this article, the salient features of validated tools to measure type 1 and 2 reactions in leprosy developed during last 7-12 years have been reviewed. The processes of validations are described too. Experience so far with the use of these severity scales to classify and monitor the anti-reaction treatment is limited. There is need to gain more experience in different endemic countries/regions so that duration and doses of anti-reaction agents could be better rationalized. Depending upon the field experience, these severity grading systems may be evolved further.

Clinico-epidemiological Profile of Erythema Nodosum Leprosum Cases in Western Odisha

This study was carried out in a hospital setting in Odisha to find out the epidemiological profile and clinical spectrum of ENL and their association with bacillary load, clinical types of leprosy and comorbid conditions of leprosy patients. Out of 1352 cases of leprosy, 97 were diagnosed with rd th ENL. Male patients outnumbered the females (4.3:1), and leprosy patients in their 3 and 4 decade were more commonly found to be having ENL. Majority of the patients belonged to the lepromatous leprosy (LL) spectrum (74.22%). A positive family history of Leprosy was obtained in 7.21% of cases. Diabetes mellitus followed by hypertension was the most common comorbid condition. Whether these conditions have any direct link with ENL needs to be investigated by proper prospective studies. 79.38% of cases had arthritis whereas glomerulonephritis and peripheral edema were observed in 29.89% of cases each. Observations of this study will be useful for planning field based studies in population from Odisha.

Bullous Erythema Nodosum Leprosum: A Rare Entity

Erythema Nodosum Leprosum (ENL) usually presents in patients with Lepromatous Leprosy. It commonly presents as tender erythematous nodules but other rare forms like pustular, vesicular, bullous or necrotic have also been reported. We report a case of a 30 year old male who initially presented with erythematous tender nodules and plaques over both lower limbs with a past history of being treated for Lepromatous Leprosy. He further developed bullous lesions over the same sites. Biopsy specimen of a bulla was sent for histopathology which was suggestive of ENL. This presentation of ENL makes it an interesting case to be reported.