A borderline lepromatous patient on multibacillary MDT for 14 months develops repeated crops of painful subcutaneous nodules over the trunk and limbs, high fever, arthralgia, and tender hepatomegaly. Skin biopsy shows sheets of foamy macrophages heavily laden with AFB infiltrated by neutrophils, with vasculitic change. He does not improve with paracetamol and rest. Which specific agent is the drug of choice for this condition?
- A High-dose oral prednisolone
- B Thalidomide ✓
- C Clofazimine dose escalation alone
- D Interferon-gamma injections
Correct answer: B. Thalidomide
Explanation
This is erythema nodosum leprosum, the Type 2 reaction, an immune complex-mediated neutrophilic vasculitis occurring in multibacillary leprosy, typically during the second year of MDT. Thalidomide is the classical drug of choice for ENL in male patients because of its potent anti-TNF-alpha effect, though teratogenicity restricts its use in women of childbearing age, where corticosteroids are preferred. High-dose prednisolone is the mainstay for Type 1 reversal reactions, not ENL.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.