Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report
Erythema Nodosum Leprosum (ENL) may have a chronic course which may be recalcitrant to treatment. Preferred treatment modalities are systemic corticosteroids and thalidomide. Azathioprine, methotrexate and cyclosporine are immunosuppressants which may also be used as a steroid sparing agent. We re...
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JCDR Research and Publications Private Limited
2017-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/10499/26536_CE(RA1)_F(T)_PF1_(SY_MJ_PY)_PFA(SY_SS).pdf |
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| author | Singh Shailendra Vikram Jitendra Romita Bachaspatimayum A. Subhalakshmi Devi S. Rita |
| author_facet | Singh Shailendra Vikram Jitendra Romita Bachaspatimayum A. Subhalakshmi Devi S. Rita |
| author_sort | Singh Shailendra Vikram Jitendra |
| collection | DOAJ |
| description | Erythema Nodosum Leprosum (ENL) may have a chronic course which may be recalcitrant to treatment. Preferred treatment
modalities are systemic corticosteroids and thalidomide. Azathioprine, methotrexate and cyclosporine are immunosuppressants
which may also be used as a steroid sparing agent. We report the case of a 48-year-old male diagnosed as lepromatous leprosy that
developed ENL after four months of Multibacillary Multi-Drug Therapy (MB-MDT). He was treated with oral prednisolone (1 mg/kg/
day) which was gradually tapered upto a dose of 7.5 mg/day. He developed recurrences on and off once the dose reached the said
level and this continued for three years. Oral clofazamine (300 mg/day x 6 months; then 100 mg/day x 6 months) was also added
in the second year. Thalidomide (200 mg/day) was also given but withdrawn due to adverse effect after 10 days. Azathioprine was
started at a dose of 100 mg/day following which there was resolution of symptoms by one week and no recurrences by 10 weeks;
it was given for eight months after which the dose was tapered to 50 mg/day for another four months. Complete withdrawal of oral
prednisolone after gradual tapering was possible by 12 months of azathioprine therapy. The patient is still on regular follow-up with
no recurrences so far till the last check-up. |
| first_indexed | 2024-12-21T15:33:46Z |
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| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-12-21T15:33:46Z |
| publishDate | 2017-08-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-db9c2447b3544cf3b69a5283a67cb2d42022-12-21T18:58:42ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2017-08-01118FD01FD0210.7860/JCDR/2017/26536.10499Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case ReportSingh Shailendra Vikram Jitendra0Romita Bachaspatimayum1A. Subhalakshmi Devi2S. Rita3Postgraduate Student, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal, Manipur, India.Assistant Professor, Department of Dermatology, Venereology and Leprosy, Regional Institute of Medical Sciences, Imphal, Manipur, India.Professor, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal, Manipur, India.Professor, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal, Manipur, India.Erythema Nodosum Leprosum (ENL) may have a chronic course which may be recalcitrant to treatment. Preferred treatment modalities are systemic corticosteroids and thalidomide. Azathioprine, methotrexate and cyclosporine are immunosuppressants which may also be used as a steroid sparing agent. We report the case of a 48-year-old male diagnosed as lepromatous leprosy that developed ENL after four months of Multibacillary Multi-Drug Therapy (MB-MDT). He was treated with oral prednisolone (1 mg/kg/ day) which was gradually tapered upto a dose of 7.5 mg/day. He developed recurrences on and off once the dose reached the said level and this continued for three years. Oral clofazamine (300 mg/day x 6 months; then 100 mg/day x 6 months) was also added in the second year. Thalidomide (200 mg/day) was also given but withdrawn due to adverse effect after 10 days. Azathioprine was started at a dose of 100 mg/day following which there was resolution of symptoms by one week and no recurrences by 10 weeks; it was given for eight months after which the dose was tapered to 50 mg/day for another four months. Complete withdrawal of oral prednisolone after gradual tapering was possible by 12 months of azathioprine therapy. The patient is still on regular follow-up with no recurrences so far till the last check-up.https://jcdr.net/articles/PDF/10499/26536_CE(RA1)_F(T)_PF1_(SY_MJ_PY)_PFA(SY_SS).pdfcorticosteroidlepra reactionlepromatous leprosy |
| spellingShingle | Singh Shailendra Vikram Jitendra Romita Bachaspatimayum A. Subhalakshmi Devi S. Rita Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report Journal of Clinical and Diagnostic Research corticosteroid lepra reaction lepromatous leprosy |
| title | Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report |
| title_full | Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report |
| title_fullStr | Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report |
| title_full_unstemmed | Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report |
| title_short | Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report |
| title_sort | azathioprine in chronic recalcitrant erythema nodosum leprosum a case report |
| topic | corticosteroid lepra reaction lepromatous leprosy |
| url | https://jcdr.net/articles/PDF/10499/26536_CE(RA1)_F(T)_PF1_(SY_MJ_PY)_PFA(SY_SS).pdf |
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