A lepromatous leprosy patient on multidrug therapy develops crops of painful erythematous nodules on the face and limbs with fever and joint pains. After supportive care fails to control the episode, the drug of choice specifically for severe recurrent episodes of this reaction is:
- A Clofazimine
- B Thalidomide ✓
- C Prednisolone
- D Isoniazid
Correct answer: B. Thalidomide
Explanation
This is erythema nodosum leprosum, a type 2 lepra reaction caused by immune complex deposition and TNF-alpha release. Thalidomide suppresses TNF-alpha and is the most effective agent for severe or recurrent ENL, though its teratogenicity restricts use to non-pregnant patients. Prednisolone is used for milder cases and for type 1 reactions. Clofazimine has a mild anti-inflammatory effect useful as a steroid-sparing agent, while isoniazid has no role in managing lepra reactions.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.