The role of etanercept in refractory erythema nodosum leprosum

Thangaraju, Pugazhenthan; Durai, V.; Ali, Mumtaz

doi:10.1016/j.ijmyco.2016.07.002

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…[1,2,17] Anti-TNF-α treatment, such as infliximab, [18] etanercept, [19] and adalimumab [20] for recalcitrant SPD has given good responses. The impressive clinical response was also obtained after treatment of etanercept [21][22][23] and infliximab, [24] in ENL patients. Therefore, anti-TNF-α may be considered as an alternative therapy for both SPD and ENL that has not responded to standard therapies.…”

Section: Discussionmentioning

confidence: 75%

A case of concomitant subcorneal pustular dermatosis and erythema nodosum leprosum in borderline lepromatous leprosy-relapses

Gunawan

Roslina

Suwarsa

2017

CRCP

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Subcorneal pustular dermatosis (SPD) is a rare, chronic, and recurrent pustular eruption characterized histopathologically by subcorneal pustules that contain neutrophils. SPD has been clearly reported conjunction with other diseases. Leprosy reactions are acute inflammatory process that immunologically driven on the chronic course of leprosy. Erythema nodosum leprosum (ENL) is a type II of leprosy reaction putatively can initiate SPD lesions. We report one case of concomitant SPD and ENL in borderline lepromatous leprosy-relapses. A 41-year-old man with the history of using multidrug therapy-multibacillary for leprosy presented with painful erythematous nodules on the trunk and extremities, accompanied by pustules on erythematous base on the face, arms, buttocks, and legs. There were thickening of both ulnar nerves with gloves and stocking hypesthesia. The bacterial index was 3+ and morphological index was 20%. Histopathological examination on the pustule revealed subcorneal pustules with exocytosis of neutrophils which supported the diagnosis of SPD. A possible immunologic mechanism has been suggested in the induction of the occurence both SPD and ENL.

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Section: Discussionmentioning

confidence: 75%

A case of concomitant subcorneal pustular dermatosis and erythema nodosum leprosum in borderline lepromatous leprosy-relapses

Gunawan

Roslina

Suwarsa

2017

CRCP

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“…Eighteen full-text articles were assessed for eligibility, with three records excluded for insufficient patient details (diagnosis, treatment, or course were not addressed) or because it was a commentary. [6][7][8] A flowchart of included studies is depicted in Figure 1.…”

Section: Methodsmentioning

confidence: 99%

Biologics in Leprosy: A Systematic Review and Case Report

Cogen

Lebas

Barros

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Tumor necrosis factor (TNF)-α inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-α inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-α inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNFα inhibitors. Finally, TNF-α inhibitors appear effective in some cases of refractory ENL.

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“…As per WHO protocol, these medications are only used as an alternative or substitute in cases of drug resistance. 11 The patient could develop recurrent erythema nodosum leprosum in a span of 5-6 years, so back-up drugs like clofazimine, thalidomide, and biological agents have to be kept in mind in case of such multiple episodes. 12 The fact that the participant received the first dosage of a COVID-19 vaccine is reported in the article, but no comment or advice is given regarding the second dose.…”

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confidence: 99%