Leprosy Mailing List – November 19th, 2012
Ref.: ENL reaction in the first trimester of pregnancy.
From: B Naafs, Munnekeburen, Netherlands
Dear Dr Ghate,
Thank you very much for sharing your case and pictures with us [LML Nov. 14th, 2012]. The best person to answer your question is Dr Duncan. But I can give you my opinion.
I agree with your diagnosis. The clinical picture is consistent with ENL; the fever and high leucocytes count go with it. The histology description is that of lepromatous (LL) leprosy; with some neutrophils and nuclear dust (this is dead neutrophils).
One of the good things is that ENL is usually self-limiting but, in pregnancy it may continue for some time. I think you should start with anti-leprosy treatment. The treatment with lamprene (clofazimine) and dapsone is time honoured safe, though a few colleagues have in the past expressed their doubts.
There has been some doubt on Rifampicin too, but I think it is time honoured safe too. ENL and leprosy are more threats to the foetus, it may result in dead babies and small babies. I have read the papers [you are referring to] on the safety or non-safety of antimalarials as well, but think that the diseases they prevent respectively "cure" are more severe.
The use of steroids to cure the disease ENL is warranted but short (duration of ENL is between 2-4 weeks), maintenance dose may not prevent a new ENL. You may even give lamprene in a slight higher dose than in the standard MDT.
With kind regards,
Ben
LML - S Deepak, B Naafs, S Noto and P A M Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83 - Fax: (+39) 010 555 66 41 - E-mail: salvatore.noto@hsanmartino.it
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