Monday, November 10, 2008

Histoid leprosy

Leprosy Mailing List, October 31st, 2008

Ref.: Histoid leprosy
From: Ranawaka R., Anuradhapura, Sri Lanka

Dear Dr Salvatore,

Thank you very much for the clinical experience given by members of the LML regarding my previous clinical problems (recurrent type I reaction and nerve abscess). I have another patient whom I would like expert's opinion on management.

A 46-year-old woman with borderline lepromatous (BL) leprosy was started on multibacillary multi-drug therapy (MB-MDT) 15 months ago. When she was on her 6th month of therapy she developed type I reaction which we treated with 12-weeks oral prednisolone regime. At the 10th month of MB-MDT she developed painless discrete nodules of 1cm diameter on face and limbs. Skin biopsy revealed “histoid” leprosy.

We completed 12 MB blister packs, but skin nodules persisted; therefore the morphological index (MI) was performed, which was 5%. We continued MB blister packs. After 1 month (13th month) the MI was 0%. But at 14th month these nodules ulcerated. I added ofloxacin 400mg daily with MB therapy. Now ulceration healed and some of the nodules have disappeared.

For how long it would be safe to continue ofloxacin? Until the lesions are fully flattened? My plan is to continue MB treatment for 24 months. How do assess cure in this patient?

Your opinion regarding management of this patient will be greatly appreciated.

Kind regards,

Ranthilaka Ranawaka
Consultant Dermatologist
Teaching Hospital Anuradhapura
Sri Lanka

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