A patient on multidrug therapy for leprosy (WHO MDT) develops sudden onset acute inflammation in old leprosy lesions with fever and nerve pain. This is a Type 1 (reversal) reaction. The appropriate pharmacological management is:

• A Thalidomide to suppress the cytokine-mediated reaction and discontinue dapsone
• B Clofazimine dose escalation for its anti-inflammatory effect, stopping rifampicin
• C Corticosteroids (prednisolone) to suppress the acute cellular immune response, while continuing MDT unchanged ✓
• D Chloroquine for its immunomodulatory effect and temporary MDT interruption

Explanation

Type 1 (reversal) reactions are delayed hypersensitivity (Type IV) reactions triggered by increased cell-mediated immunity against M. leprae antigens, typically occurring in borderline leprosy. Corticosteroids (prednisolone 40–60 mg/day, tapered over 6–12 months) are the cornerstone of treatment to reduce inflammation and prevent irreversible nerve damage. MDT must never be stopped; antileprosy treatment continues throughout the reaction. Thalidomide is used for Type 2 (ENL) reactions, particularly in males; it is teratogenic and contraindicated in females of childbearing potential.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.