title: Severe refractory erythema nodosum leprosum successfully treated with the tumor necrosis factor inhibitor etanercept.
abstract: Erythema nodosum leprosum (ENL), or type II reaction, is a common complication of lepromatous leprosy that can cause significant patient debility. First-line therapy includes prednisone and thalidomide, with clofazimine reserved for patients who do not respond to first-line treatment. We present the case of a 33-year-old woman with ENL that failed to respond adequately to conventional therapy over a 6-year period. Because of the severe nature of her disease and the adverse effects of therapy that she experienced, a trial of etanercept was undertaken, which led to full resolution of her ENL. The rationale behind our choice of therapy and its future implications are discussed.
authors.affiliation: Department of Dermatology, University of Ottawa, Ottawa.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Ramien
authors.forename: Alexander
authors.initials: A
authors.lastname: Wong
authors.forename: Jay S
authors.initials: JS
authors.lastname: Keystone
mesh_terms: D000328:Adult; D004893:Erythema Nodosum / Q000188:drug therapy*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D015440:Leprosy, Lepromatous / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept