Type 2 lepra reaction in an immunocompromised patient precipitated by filariasis

Singh, Satyendra Kumar; Sharma, Taniya; Rai, Tulika; Prabhu, Anand

doi:10.4103/0253-7184.132418

Cited by 6 publications

(4 citation statements)

References 4 publications

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“… colchicine 0.5 mg b.i.d. thalidomide 100mg bd and stopped Rationale with respect to use of thalidomide in planned dose: 21 Satyendra Kumar Singh et al 37 Plan for Thalidomide in desired rationale dose 22 Prasan Kumar Panda et al 38 Plan for Thalidomide in desired rationale dose …”

Section: Resultsmentioning

confidence: 99%

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Thangaraju

Venkatesan

Gurunthalingam

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: Thalidomide is an anti-tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. Methods: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. Results: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. Conclusions: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.

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Section: Resultsmentioning

confidence: 99%

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Thangaraju

Venkatesan

Gurunthalingam

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…14,15 Varied mechanisms have been proposed to explain the possible role of these triggers in leprosy reactions (Table 6). 14,16–43…”

Section: Discussionmentioning

confidence: 99%

Time to revisit the purported link of leprosy reactions with infective triggers: An unnecessary economic burden for patients

Muddebihal,

Sardana,

Khurana

et al. 2023

Trop Doct

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Existing literature on factors triggering leprosy reactions is based only on case reports and case series, and thus probably gives a biased view. We undertook a case–control study to investigate such purported trigger factors in 42 leprosy reaction patients and 40 non-reactional controls, and the cost of investigations required for the same. Detailed history, clinical evaluation and investigations for triggers were carried out. Infections (typhoid, dental caries) were the most common triggers found, followed by pregnancy. Trigger factors were commoner in the type 2 reaction (T2R) group compared to type 1 (T1R) reaction group. There was however no statistical difference between the two groups. The average estimated cost of investigations was higher in the reactional group and this difference was statistically significant. Hence, except for essential investigations required for initiating steroids, an extensive battery of investigations is unjustified unless the medical history suggests a definitive infective trigger.

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“…T2R can occur before, during, or after MDT (Singh et al 2014 ) and most often occur during treatment (Putinatti MS de et al 2014 ) because MDT, while eliminating the live bacterium, increases the number of fragmented bacilli and circulating antigens (Antunes et al 2016 ), thereby facilitating the formation of immune complexes. Furthermore, MDT has been linked to a shift from Th2 to Th1 and Th17 responses, potentially increasing the likelihood of T2R development in the host (Fonseca AB de et al 2017 ).…”

Section: Immune Response In Type 2 Leprosy Reactions (T2r) or Erythem...mentioning

confidence: 99%

Leprosy reactions: Unraveling immunological mechanisms underlying tissue damage in leprosy patients

Serrano-Coll,

Wan,

Restrepo-Rivera

et al. 2024

Pathogens and Disease

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Leprosy is a chronic granulomatous infectious and disabling disease caused by two mycobacteria, Mycobacterium leprae and Mycobacterium lepromatosis. Acute inflammatory responses, known as leprosy reactions, are significant contributors to disabilities. Three types of leprosy reactions have been identified based on excessive cytokine release (e.g. type 1) or the accumulation of immune complexes in tissues inducing multiorgan damage (e.g. types 2 and 3). The type of leprosy reaction has implications on treatment and management strategies, yet are not well understood by health workers caring for leprosy patients. We attempt to describe the immunologic mechanisms behind the different leprosy reactions and the rationale for tailoring clinical treatment and management to the particular type of leprosy reaction based on the underlying immunologic situation.

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Type 2 lepra reaction in an immunocompromised patient precipitated by filariasis

Cited by 6 publications

References 4 publications

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Time to revisit the purported link of leprosy reactions with infective triggers: An unnecessary economic burden for patients

Leprosy reactions: Unraveling immunological mechanisms underlying tissue damage in leprosy patients

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