Recurrent ENL Reaction in MB Leprosy Patient: a Case Report

Authors: Irsalina Husna Azwir, Widyawati Djamaluddin, Safruddin Amin, Sri Vitayani Muchtar, Dirmawati Kadir, Anni Adriani

Abstract

Introduction: Erythema nodusum leprosum (ENL) is a leprosy reaction mediated by type III hypersensitivity reaction. It is characterized by painful erythematous nodules preceded by prodromal symptoms and may occur before, during, or after treatment.

Case Report: We report a 31-year old male with generalized painful erythematous nodules and intermittent fever in the last 3 months. The patient was previously diagnosed with multibacillary (MB) leprosy and was prescribed and WHO multidrug therapy (MDT) 3 years ago. Following completion of the therapy, the lesions still frequently recurred and was treated with 20 mg/day prednisone. However, once the treatment was stopped, nodules grew back and prompted re-administration of prednisone. Histopathology examination showed epidermal atrophy, granuloma in the dermis, bacilli in the blood vessel and foamy cells. The patient was subsequently successfully treated with MDT-MB and 30 mg/day prednisone tapered down every 2 weeks.

Conclusion: This case describes a recurrent ENL reaction in a MB leprosy patient which was successfully treated with oral corticosteroid and MDT MB regimen. Proper understanding of the pathomechanism of ENL reaction is needed to administer optimal management approach.

 

Citation

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Keywords

Erythema Nodusum Leprosum (ENL), Leprosy, Multibacillary, Recurrent

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