Leprosy Mailing List – December 8, 2019
Ref.: (LML) ENL and pregnancy
From: Wim van Brakel, Nieuwegein, the Netherlands
A very interesting case brought by Dr. Ramesh Sharma (LML, December 6, 2019). The treatment of a pregnant woman patient with ENL is indeed a challenge! However, in my view, terminating the pregnancy just to be able to give thalidomide is not an option, since neither the life of the mother or the child is directly at risk. I'm sure INF will share this view.
Is the patient already on high-dose clofazimine? It is important for her to have a very thorough check-up for any concurrent infection that may trigger the ENL, which may also be dental, intestinal, vaginal or STI. Optimal hydration and mild anxiolytics may also help. ENL reaction may be triggered by stress and anxiety and may in turn cause anxiety also, thus creating a vicious cycle. Appropriate counselling is therefore also very important. This should include the assurance that neither leprosy itself, any ENL reaction, nor the treatment used are harmful for the baby.
If you do have to use prednisolone, this may trigger diabetes in some patients. When I worked at Green Pastures, I remember having patients like this. Usually the diabetes could not be controlled well with insulin, so best to stick with oral antidiabetics if necessary. The diabetes was usually transient and blood sugars returned to normal after the steroids were phased out. Prednisolone treatment should be kept as short as possible: high-dose start (40-60 mg, depending on weight), quickly tapering when the reaction responds, stopping completely in between episodes, if possible.
Prof Diana Lockwood (LSHTM), Dr Stephen Walker (LSHTM) and Dr Mahesh Sharma (Anandaban Leprosy Hospital) are all very experienced in the treatment of ENL, so may have additional advice to offer regarding management of ENL during pregnancy.
I pray for wisdom for you and healing for this lady!
Wim van Brakel
Medical Director NLR
(former Green Pastures Superintendent)
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << email@example.com
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