Objective:To determine the clinical features predicting erythema nodosum leprosum(ENL) in a non endemic leprosy area.Methods:Twenty newly diagnosed patients with MBL attending the skin clinic,Sarawak General Hospital ...Objective:To determine the clinical features predicting erythema nodosum leprosum(ENL) in a non endemic leprosy area.Methods:Twenty newly diagnosed patients with MBL attending the skin clinic,Sarawak General Hospital from 1992 to 2007 were analyzed.They were divided into 2 groups,one with ENL and one without. Analysis of the presenting clinical features was done to determine the risk factors for ENL.Chi square and student t test was used for statistical analysis.Level of significance was set at 0.05.Results:ENL was present in 40%patients,all with lepromatous leprosy(LL).Clinical features that were seen more frequently in patients developing ENL include earlobe thickening(100%cf.25%,P =0.00),loss of the lateral third of the eyebrows(75%cf.16.7%,P=0.02) and mean bacteriology index(BI)(5.1 cf.2.9,P=0.03) and mean morphological index(MI)(17.8 cf.7.0,P =0.02).Number of thickened nerves(mean 2.5 cf. 1.4,P = 0.12),number of skin lesions(mean 19.4 cf.10.9,P = 0.15) and duration of illness(mean 15. 3 cf.12.8 months,P =0.68) did not predict ENL development.Conclusion:Finding LL patients with thickened earlobes,loss of lateral third of the eyebrow,high BI and MI should alert treating clinician to the possibility of ENL in a non endemic leprosy area.展开更多
Objective:This study was performed to compare the efficacy and safety of methotrexate(MTX)plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum(ENL).Methods:This comparative clin...Objective:This study was performed to compare the efficacy and safety of methotrexate(MTX)plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum(ENL).Methods:This comparative clinical study was performed in the Chittagong Medical College Hospital,Bangladesh from June 2018 to December 2019.Nineteen patients were selected according to inclusion criteria and randomly allocated to either the MTX plus prednisolone group(Group A,n=10)or the prednisolone monotherapy group(Group B,n=9).All patients were followed up until the end of the 6-month duration of therapy to observe the clinical outcomes and adverse effects.Results:All patients in both groups showed significant improvement(P=0.005 and P=0.008 in Group A and B,respectively).However,prednisolone-related adverse events were more frequent in Group B.Conclusion:The present study has demonstrated that a combination of prednisolone and MTX is a safer and more effective treatment than steroid monotherapy in ENL patients including the healing of nodules.However,this combination therapy did not appear to have a significant steroid-sparing effect,possibly because of the small sample size and short study period.Therefore,a well-designed multicenter randomized controlled trial is recommended for validation of MTX with prednisolone for the management of ENL.展开更多
Rationale:Leprosy,a chronic granulomatous disease often present clinically as erythema nodosum leprosum,a type 2 reaction.The involvement of cochlear part of audiovestibular system is a rarity.Patient concerns:A 26-ye...Rationale:Leprosy,a chronic granulomatous disease often present clinically as erythema nodosum leprosum,a type 2 reaction.The involvement of cochlear part of audiovestibular system is a rarity.Patient concerns:A 26-year-old male patient with lepromatous leprosy developed bilateral sensorineural hearing loss(SNHL)during type 2 reactional episode.Diagnosis:Recurrent erythema nodosum leprosum in rifampicin-resistant lepromatous leprosy.Interventions:Corticosteroids and second-line multidrug therapy.Outcomes:The patient improved significantly and was further referred for management of psychosocial impact due to sensorineural hearing loss.Lessons:The hearing impairment is a rare complication of type 2 reaction.Any patient with suspected cranial nerve involvement should essentially be screened by tuning fork tests for early detection of hearing impairment and offer timely intervention as required.All high bacteriological index cases should be investigated for antimicrobial resistance in high endemic areas.展开更多
文摘Objective:To determine the clinical features predicting erythema nodosum leprosum(ENL) in a non endemic leprosy area.Methods:Twenty newly diagnosed patients with MBL attending the skin clinic,Sarawak General Hospital from 1992 to 2007 were analyzed.They were divided into 2 groups,one with ENL and one without. Analysis of the presenting clinical features was done to determine the risk factors for ENL.Chi square and student t test was used for statistical analysis.Level of significance was set at 0.05.Results:ENL was present in 40%patients,all with lepromatous leprosy(LL).Clinical features that were seen more frequently in patients developing ENL include earlobe thickening(100%cf.25%,P =0.00),loss of the lateral third of the eyebrows(75%cf.16.7%,P=0.02) and mean bacteriology index(BI)(5.1 cf.2.9,P=0.03) and mean morphological index(MI)(17.8 cf.7.0,P =0.02).Number of thickened nerves(mean 2.5 cf. 1.4,P = 0.12),number of skin lesions(mean 19.4 cf.10.9,P = 0.15) and duration of illness(mean 15. 3 cf.12.8 months,P =0.68) did not predict ENL development.Conclusion:Finding LL patients with thickened earlobes,loss of lateral third of the eyebrow,high BI and MI should alert treating clinician to the possibility of ENL in a non endemic leprosy area.
基金The authors thankfully acknowledge the assistance of Mr. Sultan Md Elias Uddin. Program Manager, Leprosy control project, Chittagong.
文摘Objective:This study was performed to compare the efficacy and safety of methotrexate(MTX)plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum(ENL).Methods:This comparative clinical study was performed in the Chittagong Medical College Hospital,Bangladesh from June 2018 to December 2019.Nineteen patients were selected according to inclusion criteria and randomly allocated to either the MTX plus prednisolone group(Group A,n=10)or the prednisolone monotherapy group(Group B,n=9).All patients were followed up until the end of the 6-month duration of therapy to observe the clinical outcomes and adverse effects.Results:All patients in both groups showed significant improvement(P=0.005 and P=0.008 in Group A and B,respectively).However,prednisolone-related adverse events were more frequent in Group B.Conclusion:The present study has demonstrated that a combination of prednisolone and MTX is a safer and more effective treatment than steroid monotherapy in ENL patients including the healing of nodules.However,this combination therapy did not appear to have a significant steroid-sparing effect,possibly because of the small sample size and short study period.Therefore,a well-designed multicenter randomized controlled trial is recommended for validation of MTX with prednisolone for the management of ENL.
文摘Rationale:Leprosy,a chronic granulomatous disease often present clinically as erythema nodosum leprosum,a type 2 reaction.The involvement of cochlear part of audiovestibular system is a rarity.Patient concerns:A 26-year-old male patient with lepromatous leprosy developed bilateral sensorineural hearing loss(SNHL)during type 2 reactional episode.Diagnosis:Recurrent erythema nodosum leprosum in rifampicin-resistant lepromatous leprosy.Interventions:Corticosteroids and second-line multidrug therapy.Outcomes:The patient improved significantly and was further referred for management of psychosocial impact due to sensorineural hearing loss.Lessons:The hearing impairment is a rare complication of type 2 reaction.Any patient with suspected cranial nerve involvement should essentially be screened by tuning fork tests for early detection of hearing impairment and offer timely intervention as required.All high bacteriological index cases should be investigated for antimicrobial resistance in high endemic areas.
