Leprosy Mailing List – May 5, 2015
Ref.: (LML) Parenteral treatment of leprosy reactions
From: Jingquan Wang, Zhejiang, PR China
Dear Pieter,
Greetings from a leprosy colony in Zhejiang Province, China. I write this letter in response to the request from Herman Harun, LML April 28, 2015.
I have seen a leprosy reaction case treated with a bolus of 150mg Dexamethasone for 3 days and continued orally prednisone prescribed by a village doctor in Jiangsu, China.
Fifteen years ago, I worked as a leprosy control doctor in a small county in Jiangsu, China. One day, the patient aged 60 years old, BL classification, came to our leprosy control section for regular treatment. He had been treated with MDT for over 3 years. The patient presented with oedematous skin lesions and swollen nerve trunks with nerve pains. So we diagnosed him type 1 reaction and asked him to go to the village medical station for further treatment. We give him a prescription of hydrocortisone 150 mg infusion with glucose 250 ml. Unfortunately, the village doctor had no hydrocortisone injection, so he replaced it with dexamethasone of same dosage (of 150 mg dexamethasone). After three days infusion, the patient came to our hospital and told me the village doctor treated him with dexamethasone of same dosage. We immediately asked the village doctor stop the treatment and give the patient prednisone 80 mg /day for several weeks. However, the leprosy reaction soon relapsed. It turned out that the patient had developed adrenal insufficiency and needed oral prednisone replacement of adrenal function for life. So I do not think severe leprosy reaction should be treated with methylprednisolone pulse therapy. Such bolus therapy could do more harm than good in treating leprosy reaction. I strongly suggest not to use this technique to treat leprosy reactions.
I am still very sorry for the patient. I have heard he had passed ten years ago. I scolded the village doctor. The patient forgave him.
Best wishes,
Jingquan Wang
Chief Physician,
Department of leprosy treatment
Institute of Dermatology of Zhejiang Province,China
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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