Leprosy Mailing List – December 20 , 2013
Ref.: (LML) Thalidomide in treating kidney involvement in ENL
From: Ben Naafs, Munnekesburen, the Netherlands
Dear dr Jingquan Wang,
Thank you for your quick response. I wonder did you do a culture (and sensitivity)? Are there colic pains? In other words, I think that you have to look for another cause for the blood and leucocytes in the urine.
Concerning the side effects of thalidomide yes, headache can occur, but the hypertension is most often pulmonary. But it could be wise to stop.
I understand GTW is a drug used in China for proteinuria, supressing male fertility and as a immunosuppressor.
I agree with you that neuritis and iritis in reactions often need steroids. But particular in chronic ENL I think steroids should be used cleverly and intermittently.
Are there studies comparing GTW with other ways of handling ENL? I have no experience with it and from what I know as a immunosuppressant it is not strong. Hence you advice it as a not first line drug in ENL.
Concerning thalidomide as first line drug I have no strong opinion, I usually used steroids, but that has to do with the availability of the drug. Again the Brazilians will have most experience. In the past in Africa I saw most severe ENL in man. Now with the availability in Brazil for man I see most severe and chronic ENL in woman. So thalidomide certainly has a place. I think it even may prevent ENL, when the relative low dose steroids that do not.
But as far as I understood the ENL is in remission.
I wish you strength in handling this patient.
With great regards
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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