A lepromatous leprosy patient on multidrug therapy develops recurrent episodes of fever, tender erythematous skin nodules, iritis and orchitis. Episodes recur despite standard supportive measures. Which drug is considered the agent of choice for controlling these recurrent episodes?
- A Thalidomide ✓
- B Clofazimine
- C Prednisolone
- D Dapsone
Correct answer: A. Thalidomide
Explanation
Erythema nodosum leprosum is a type 2, immune-complex mediated reaction occurring in lepromatous and borderline lepromatous disease. Thalidomide is the drug of choice for severe or recurrent ENL because it suppresses tumour necrosis factor alpha production by monocytes. Its teratogenicity restricts use in women of childbearing age, in whom corticosteroids or clofazimine are alternatives. Dapsone treats the infection itself and has no role in reaction control.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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