A patient treated for lepromatous leprosy with MDT develops painful, tender erythematous nodules on the face, trunk, and limbs, accompanied by fever, acute iritis, and painful epididymo-orchitis. The Mitsuda (lepromin) test is negative. What is the first-line treatment for this reaction?
- A High-dose prednisolone 40–60 mg/day
- B Thalidomide 400 mg/day (initial dose) ✓
- C Clofazimine 300 mg/day
- D Chloroquine 250 mg/day
Explanation
Erythema nodosum leprosum (ENL, Type 2 reaction) is an immune complex–mediated reaction (Type III hypersensitivity) in lepromatous (LL) and borderline lepromatous (BL) leprosy. Thalidomide is the drug of choice for ENL due to its powerful anti-TNF-alpha action — it is approved specifically for this indication and controls ENL dramatically. However, it is absolutely contraindicated in women of reproductive age due to teratogenicity. In such cases, prednisolone is used. Clofazimine is an alternative for chronic recurrent ENL. MDT must be continued throughout the reaction.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.