Leprosy Mailing List – December 9, 2019
Ref.: (LML) ENL and pregnancy
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
Dr. Ramesh Sharma (LML, December 6, 2019) puts forward a difficult and ethical question. It is scientifically difficult because we have few parameters to tell what will be the future. We assume that it will continue. What is her BI? Does she already have objective nerve involvement.
The one who has studied it was Elisabeth Duncan. I was with her in Alert. One thing she noticed was that patients on higher dose of clofazimine did better than the ones on Dapsone only, and the birthweight of the baby was higher.
Give dapsone 100mg daily instead of 50 and try to give prednisolone high dose only when the ENL is active and to down to zero within a month. When it starts again (even in the time you went down) you give the dose that suppressed ENL and go down again. Take care of the side effects of steroids. Medium dose steroids does not prevent a new ENL.
MTX would be a safer option than thalidomide. It is already after 3 months and I do not know the weight of the lady but I suspect low. So, 7,5 mg once a week with Folic acid not on the day that MTX is given may be added as maintenance to the intermittent steroids. But try steroids alone first.
The ethical question I have no solution. I think from the results of Duncan it is possible to keep the pregnancy. But when you consider the thalidomide the most crucial episode is already passed.
I hope this helps. Otherwise come back to me.
Regards and wisdom,
Ben
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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