Methotrexate in erythema nodosum leprosum: Pitfalls to avoid

Tropical Doctor ◽

10.1177/00494755211056170 ◽

2021 ◽

pp. 004947552110561

Author(s):

Hitaishi Mehta ◽

Tarun Narang ◽

Sunil Dogra ◽

Bhushan Kumar

Keyword(s):

Low Dose ◽

Erythema Nodosum ◽

Short Report ◽

Dose Methotrexate ◽

Atypical Features ◽

Erythema Nodosum Leprosum

We read with interest the short report by Rani et al. entitled “An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases.” The article describes two cases of erythema nodosum leprosum (ENL) with ‘atypical features’ and good response to low dose methotrexate. The authors address a few concerns regarding methotrexate in ENL, emphasizing the rational usage of this agent.

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An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases

Tropical Doctor ◽

10.1177/00494755211016652 ◽

2021 ◽

pp. 004947552110166

Author(s):

Seema Rani ◽

Sweta Singh ◽

Diksha Agrawal ◽

Kabir Sardana ◽

Arvind Ahuja

Keyword(s):

Low Dose ◽

Erythema Nodosum ◽

Type I ◽

Type Ii ◽

Permanent Disability ◽

Atypical Features ◽

Erythema Nodosum Leprosum

Reactions in leprosy are acute inflammatory episodes that can be classified as type I or type II. Recognition and timely management of these patients is critical to avoid permanent disability. We present two cases of erythema nodosum leprosum, presenting with recurrent atypical features, responding well to a low dose of methotrexate.

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Case Report: Rapid Response to Low-Dose Thalidomide in a Case of Severe Steroid Recalcitrant Erythema Nodosum Leprosum

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0683 ◽

2021 ◽

Author(s):

B. Savitha ◽

Kabir Sardana ◽

Ritu Kumari ◽

Ananta Khurana ◽

Surabhi Sinha ◽

...

Keyword(s):

Low Dose ◽

Erythema Nodosum ◽

Lepromatous Leprosy ◽

High Dose ◽

Effective Treatment Option ◽

Steroid Dependence ◽

Erythema Nodosum Leprosum ◽

Organ Specific ◽

Inflammatory Drugs

Erythema nodosum leprosum (ENL), or type 2 lepra reaction, presents with crops of evanescent, tender erythematous nodules accompanied by fever, arthralgia, weight loss, malaise, and organ-specific manifestations, and is seen in borderline and lepromatous leprosy. The drugs approved for ENL include nonsteroidal anti-inflammatory drugs, systemic steroids, thalidomide, and clofazimine. The management of ENL is challenging because long-term steroid use leads to steroid dependence. Our patient had severe steroid recalcitrant ENL with vesicular and pustular lesions mimicking Sweet’s syndrome, and was treated effectively with a low-dose thalidomide regimen (100 mg/d) as opposed to the high dose (400 mg/d) recommended in the literature. We discuss the patho-mechanics and clinical utility of a low-dose thalidomide regimen as an effective treatment option for ENL.

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