Leprosy Mailing List – December 20, 2013
Ref.: (LML) Thalidomide in treating kidney involvement in ENL
From: Jingquan Wang, Zhejiang, China
Dear Pieter,
We have consider the proposal of Dr Ben Naafs that there could be urinary tract infection and azithromycin 1g daily for 2days was prescribed, but it did not work and blood in urine and leukocyturia is still present.
Forty five days after the start of thalidomide, a severe headache happened in the patient with a slight high blood pressure. We had to stop thalidomide and a drug named multi-glycosides of triptergium wilfordii hook f (MGTW) which has the effect to control ENL and kidney damage and recommended by China leprosy control programme, with a dosage of 60 mg daily, was used to continue the therapy.
Now we have treated the patient as such for two weeks and still no response in mitigating the kidney involvement. I think maybe we have to use prednison to treat the patient despite of her slow virus hepatitis B infection. The iridocyclitis of the patient is well controlled with cortisone eye drops and atropine eye gel during the initial several days.
In my view, I think short course predinison is imperative in severe ENL cases, especially for those cases with neuritis, iritis and kidney involvement. For severe cases or chronic cases, drugs such as thalidomide, multi-glycosides of triptergium wilfordii hook f (MGTW), B663(which is not available in China) should not be chosen as the first line drug in controlling ENL.
Best regards.
Jingquan Wang
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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