Leprosy Mailing List – August 22, 2018
Ref.: (LML) Patient with severe adverse effects due to steroids
From: Wim Theuvenet, Apeldoorn, the Netherlands
Dear Pieter,
Thanks to Dr. Sharma you for sharing this problem (LML, August 19, 2018).
Please allow for some questions and suggestions:
1. Dr. Sharma mentions BT and type 1 reaction.
Q: is there also a type II component?
2. In my experience one can try tapering off the Prednison while keeping an umbrella of Clofazimine 100 mg TDS.
Suggestion: The combination of Prednison and Clofazimine creates an increased risk of gastrointestinal erosions/bleeding. Therefore, it is advisable to be very hesitant in adding analgesics that also have an anti-inflammatory component, any how it is wise to prescribe anti-acids to protect the stomach, and to check Hb and the faecal occult blood test once a week! Trust that is already in your protocol?
3. Type 1 frequently causes enlargement of (painful) nerves and nerve function loss.
Suggestion: When this is the case please consider a nerve decompression of the affected nerves to strongly reduce the pain and hopefully restore nerve function! This may also help in reducing the type 1 reaction symptoms and thus the need for high dosages of the above discussed drugs?
When in any doubt you can always seek the advice of Dr Indra Napit, of Anandaban Leprosy hospital.
From Dr Wim Brandsma there is a suggestion that I to visit GP Hospital early November, this prior to the Surgical Course at Anandaban. Perhaps there will be an opportunity to see some patients together, learn from each other, and perhaps do some surgery?
With best regards,
Willem Theuvenet
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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