A leprosy patient on MDT (dapsone + clofazimine + rifampicin) develops sudden onset of tender erythematous nodules on the face and limbs with fever and arthralgia. His lepromin test is negative. Histology of a nodule shows edema in the dermis with neutrophilic and eosinophilic infiltrate around vessels, without classic granuloma formation. He had been classified as lepromatous leprosy. This reaction is best treated with:
- A Prednisolone 40 mg/day
- B Clofazimine dose increase
- C Dapsone dose increase
- D Thalidomide 100–300 mg/day ✓
Explanation
This is Erythema Nodosum Leprosum (ENL/Type II reaction), occurring in LL/BL leprosy, characterised by tender erythematous nodules, fever, and constitutional symptoms. Histology shows acute neutrophilic infiltrate with immune complex deposition — distinct from the reversal reaction (Type I) which shows upgrading granuloma formation. Thalidomide (100–300 mg/day) is the drug of choice for ENL, acting by inhibiting TNF-α synthesis. It is contraindicated in women of childbearing age due to teratogenicity. Prednisolone is used when thalidomide is contraindicated (e.g., women of reproductive age). Clofazimine (300 mg/day) is used for chronic/recurrent ENL.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.