A 30-year-old woman with borderline lepromatous leprosy on MDT presents with crops of painful erythematous nodules, fever and joint pains, consistent with erythema nodosum leprosum. She is found to be pregnant. Which drug, classically effective for this reaction, must be avoided, and why?
- A Thalidomide, because it is a potent human teratogen causing limb reduction defects ✓
- B Clofazimine, because it causes severe skin pigmentation in the fetus
- C Prednisolone, because corticosteroids cause cleft palate in the first trimester
- D Chloroquine, because it causes retinal toxicity in utero
Correct answer: A. Thalidomide, because it is a potent human teratogen causing limb reduction defects
Explanation
Thalidomide is highly effective for type 2 lepra reaction (ENL), suppressing TNF-alpha production, but it is absolutely contraindicated in pregnancy because it causes phocomelia and other limb reduction defects; strict pregnancy prevention programmes accompany its use. In pregnant women with ENL, corticosteroids such as prednisolone are used instead. Clofazimine pigmentation is a maternal cosmetic issue, not the reason for avoidance here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.