A patient with borderline lepromatous leprosy on multidrug therapy develops crops of painful erythematous nodules, fever, arthralgia, and tender neuritis. Skin smear shows fragmented bacilli. Which drug is considered the treatment of choice for this reaction?
- A Prednisolone
- B Thalidomide ✓
- C Clofazimine
- D Chloroquine
Correct answer: B. Thalidomide
Explanation
This is erythema nodosum leprosum, the type 2 lepra reaction, an immune complex mediated phenomenon. Thalidomide is the drug of choice for severe ENL because it suppresses tumor necrosis factor alpha production from monocytes. It is strictly contraindicated in pregnancy and in women of childbearing potential without strict contraception. Steroids are preferred when thalidomide cannot be used, such as during pregnancy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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