title: Role of azathioprine in preventing recurrences in a patient of recurrent erythema nodosum leprosum.
abstract: The pathogenesis of erythema nodosum leprosum (ENL) involves both immune complex deposition and dysfunction of cell mediated immunity. Tumour necrosis factor-alpha (TNF-alpha) plays an important role in its pathogenesis. Thalidomide and corticosteroids are the mainstay of treatment for ENL. However, there are often severe limitations to their use. We report a case of recurrent ENL treated successfully with azathioprine. A 15-year-old unmarried girl with lepromatous leprosy had recurrent ENL for 2 years. She was treated with WHO-MB MDT and prednisolone in doses of 40-90 mg a day for 2-12 weeks. Her condition was inadequately controlled. The patient was therefore treated with thalidomide 300 mg and prednisolone 40 mg. The symptoms subsided after 5 days and ENL lesions healed in 2 weeks. Prednisolone was reduced by 10 mg per week and stopped, while thalidomide was reduced to 100 twice daily after 4 weeks. Azathioprine 100 mg (2 mg/kg per day) daily orally was added to prevent recurrences. Thalidomide was further reduced and stopped after another 4 weeks while she continued with azathioprine in the same doses for 8 months. There was no recurrence of ENL lesions and no side effects of the therapy. MB-MDT was stopped 1 year ago, and she is on follow-up without any relapse. Azathioprine, therefore, appears to be an effective and safe drug to prevent recurrences of ENL.
authors.affiliation: Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. prokverma@hotmail.com
authors.forename: Kaushal K
authors.initials: KK
authors.lastname: Verma
authors.forename: P
authors.initials: P
authors.lastname: Srivastava
authors.forename: Anil
authors.initials: A
authors.lastname: Minz
authors.forename: Kamna
authors.initials: K
authors.lastname: Verma
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D004893:Erythema Nodosum / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007917:Leprostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015440:Leprosy, Lepromatous / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D055502:Secondary Prevention
chemical_list: D007166:Immunosuppressive Agents; D007917:Leprostatic Agents; D001379:Azathioprine