ENL reaction in pregnancy

 

Leprosy Mailing List – November 17^th, 2012

Ref.:    ENL reaction in pregnancy. [See attachments]
From:  ME Duncan, Peebles, Scotland

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Dear Dr Ghate,

 

Thank you very much for sharing your case [LML Nov. 14^th, 2012 - pictures are in attachment].  I am writing as an obstetrician/ gynaecologist and also leprologist.

 

We found that ENL could run throughout pregnancy.  It often starts in the first trimester; only to recur in the third trimester.  Steroids are NOT a good idea as they suppress the foetal adrenals, which can be disastrous.  We used Clofazimine in as high a dose as was necessary, starting off with 300mg daily. This caused skin pigmentation in the mother, but that fades when the clofazimine is stopped.  It is stored in fat cells and so will go into the mother's milk, which when regurgitated has the colour of strawberry ice-cream but does NOT harm the baby. 

 

Teratotoxicity?  Not a problem in women though it maybe teratocxic in rats!

 

After delivery watch out for Reversal reaction which will require steroids [Prednisolone].  This happens abruptly at 40 days after delivery.  It may appear overnight.  High doses may be required starting with 40mg daily.  Check voluntary muscle testing [hands, feet and eyes] and graded sensory skin testing [hands and feet] twice weekly.  If these do not respond to treatment or get worse increase the dose of Prednisolone by 5mg daily every three days.  We saw the dosage reach 80mg daily in some cases.  Do NOT follow the WHO guidelines of 40mg daily for 4 weeks, 30mg daily for 4 weeks, 20 mg daily for 4 weeks, 10mg daily for 4 weeks and then stop.

 

I have seen far too many women who were left with permanent hand and foot deformity.

 

Your sincerely,

 

Lysbeth Duncan

 

Dr ME Duncan me.duncan@btinternet.com

 

 

 

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