ENL reaction in pregnancy.

 

Leprosy Mailing List – November 20^th, 2012

Ref.:    ENL reaction in pregnancy.
From:  J Barreto, Bauru, S Paulo, Brazil

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Dear Salvatore,

Thank you very much to Dr Ghate for presenting his case and clinical pictures [LML Nov. 14, 2012] and thank you also to Dr Duncan and the other colleagues that have already commented.  I have seen 2 cases like this, recently (3 months ago). 

The woman is young (26yrs), and the source of M. leprae must be found.  It would be important knowing the result of the slit-skin smear examination.  She may have a high bacteriological index (I) at least 4+ or 5+; which in turn means more than 10 years of disease; usually the source of infection is a lepromatous patient many times almost asymptomatic, and it is not her husband, but her parents, or sometimes grandfather/grandmother.

MDT
In Brazil, MDT can be given to pregnant woman; it is not teratogenic.

Anti-reactional treatment
Prednisolone is also not teratogenic but, I agree with Dr Duncan about the possibility of foetal adrenal crisis at the moment of delivery.  Nevertheless, I have to say that this outcome could be easily managed with hydrocortisone.  My patients' babies did not present any endocrine problem, probably because the foetal "hypophysis – adrenal" axis is not well developed.  It must be emphasized that clofazimine takes, at least, 4 to 8 weeks to improve symptoms in ENL.  It is also important to observe that high dose of clofazimine is not well tolerated, mainly in pregnant woman; it causes (or aggravates) digestive disorder, a common condition in this group of patients.  Dental, urinary and gynaecological infection must also be ruled out, as well as diabetes.

Regards,

Jaison

 

 

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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