A 30-year-old man with lepromatous leprosy develops recurrent episodes of painful skin nodules, fever, and neuritis despite continuing multidrug therapy. He had severe drowsiness with one drug used previously. Which agent is preferred for repeated episodes of this reaction in male patients?
- A Thalidomide ✓
- B Clofazimine
- C Prednisolone
- D Chloroquine
Correct answer: A. Thalidomide
Explanation
This is type 2 lepra reaction (erythema nodosum leprosum), an immune complex mediated reaction seen in multibacillary disease. Thalidomide is highly effective for recurrent ENL, particularly in men, acting through TNF-alpha suppression. It is avoided in women of childbearing age because of severe teratogenicity (phocomelia); in them, steroids are used instead. Drowsiness is a known thalidomide side effect, explaining his previous intolerance history. Clofazimine has a mild steroid-sparing role, and chloroquine is not standard therapy.
Reference: Harrison Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.